MEDICARE: THOMAS G. BELEY, PHD, LCSW & ASSOCIATES, PA

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	SW 0000451	FL

General Provider Information

NPI Number	:	1932470598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS G. BELEY, PHD, LCSW & ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	6800 W COMMERCIAL BLVD
Second Line	:	SUITE 2
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2149
Country	:	US
Telephone Number	:	954-749-3444
Fax Number	:	954-749-4954

Provider Business Practice Location Address
First Line	:	6800 W COMMERCIAL BLVD
Second Line	:	SUITE 2
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2149
Country	:	US
Telephone Number	:	954-749-3444
Fax Number	:	954-749-4954

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS GEORGE BELEY
Credential	:	PHD, LCSW
Telephone Number	:	954-749-3444

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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