MEDICARE: MS. ELIZABETH BEVAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SL05136300	NJ

General Provider Information

NPI Number	:	1235459363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH BEVAN LCSW

Provider Business Mailing Address
First Line	:	53 S LAUREL ST
Second Line	:	SECOND FLOOR
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1946
Country	:	US
Telephone Number	:	856-451-4700
Fax Number	:	856-451-8685

Provider Business Practice Location Address
First Line	:	53 S LAUREL ST
Second Line	:	SECOND FLOOR
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1946
Country	:	US
Telephone Number	:	856-451-4700
Fax Number	:	856-451-8685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	06/11/2010

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