MEDICARE: MR. JULES E BEUCK 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	11819	CA

General Provider Information

NPI Number	:	1255754263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JULES E BEUCK LCSW

Provider Business Mailing Address
First Line	:	3288 LITTLE MOUNTAIN DR APT A
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-0912
Country	:	US
Telephone Number	:	909-520-2044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3288 LITTLE MOUNTAIN DR APT A
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-0912
Country	:	US
Telephone Number	:	909-520-2044
Fax Number	:

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

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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