MEDICARE: GRACE DOROTHY BEATTIE 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	139020	CA

General Provider Information

NPI Number	:	1588598460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE DOROTHY BEATTIE LCSW

Provider Business Mailing Address
First Line	:	1145 LARRABEE ST APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-2029
Country	:	US
Telephone Number	:	815-668-3445
Fax Number	:	815-668-3445

Provider Business Practice Location Address
First Line	:	1145 LARRABEE ST APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-2029
Country	:	US
Telephone Number	:	815-668-3445
Fax Number	:	815-668-3445

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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