MEDICARE: MR. DANIEL RICHARD BEATTY 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	104100000X	Social Worker	C004809	NC
2	1041C0700X	Clinical Social Worker	C004809	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710057476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL RICHARD BEATTY LCSW

Provider Business Mailing Address
First Line	:	219A AVERY AVE
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28655-3102
Country	:	US
Telephone Number	:	828-430-8344
Fax Number	:	828-430-4384

Provider Business Practice Location Address
First Line	:	219A AVERY AVE
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28655-3102
Country	:	US
Telephone Number	:	828-430-8344
Fax Number	:	828-430-4384

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/29/2007

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