MEDICARE: ANDREW J BEYRER LCSW, BCBA

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	CSW004944	GA
2	103K00000X	Behavior Analyst	1-13-14291	GA
3	1041C0700X	Clinical Social Worker	3737	KY

General Provider Information

NPI Number	:	1417238874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW J BEYRER LCSW, BCBA

Provider Business Mailing Address
First Line	:	705 WHITAKER ST
Second Line	:	APT A
City	:	SAVANNAH
State	:	GA
Zip	:	31401-5559
Country	:	US
Telephone Number	:	859-466-7316
Fax Number	:

Provider Business Practice Location Address
First Line	:	639 JOHN CARTER RD
Second Line	:
City	:	BLOOMINGDALE
State	:	GA
Zip	:	31302-8065
Country	:	US
Telephone Number	:	859-466-7316
Fax Number	:

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	11/04/2013

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