Provider Demographics
NPI:1124227178
Name:CAIN, BEDA JANINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BEDA
Middle Name:JANINE
Last Name:CAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 COLLEGE STATION RD
Mailing Address - Street 2:PMB 537
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605
Mailing Address - Country:US
Mailing Address - Phone:706-613-5456
Mailing Address - Fax:
Practice Address - Street 1:170 SECURITY CIRCLE
Practice Address - Street 2:SUITE 102
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-3619
Practice Address - Country:US
Practice Address - Phone:706-613-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW001294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001294Medicare UPIN