MEDICARE: NICOLE BEACH LMSW

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	104100000X	Social Worker	099216-01	NY
2	104100000X	Social Worker	099216-01

General Provider Information

NPI Number	:	1437895257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BEACH LMSW

Provider Business Mailing Address
First Line	:	11949 UNION TPKE APT 10D
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11949 UNION TPKE APT 10D
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6108
Country	:	US
Telephone Number	:	919-685-7255
Fax Number	:

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

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/06/2022

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Directions to “ NICOLE BEACH LMSW” Practice Location

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