MEDICARE: ALICIA JEAN BEYNON LISW-S, LICDC-CS

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	I.0700055-SUPV	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	ICDC.101038-CS	OH

General Provider Information

NPI Number	:	1851435523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA JEAN BEYNON LISW-S, LICDC-CS

Provider Business Mailing Address
First Line	:	1495 SUNFLOWER RD
Second Line	:
City	:	NEW CONCORD
State	:	OH
Zip	:	43762-9671
Country	:	US
Telephone Number	:	877-692-7247
Fax Number	:	877-692-7247

Provider Business Practice Location Address
First Line	:	1495 SUNFLOWER RD
Second Line	:
City	:	NEW CONCORD
State	:	OH
Zip	:	43762-9671
Country	:	US
Telephone Number	:	855-692-7247
Fax Number	:	855-692-7247

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	05/16/2016

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