Provider Demographics
NPI:1093843757
Name:ANDERSON, BEVERLY (LMSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ELSBREE ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1209
Mailing Address - Country:US
Mailing Address - Phone:570-888-5471
Mailing Address - Fax:
Practice Address - Street 1:711 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2322
Practice Address - Country:US
Practice Address - Phone:607-734-6151
Practice Address - Fax:607-734-2943
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054545-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker