Provider Demographics
NPI:1134645385
Name:NASH BEYER, DARNELL DALE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DARNELL
Middle Name:DALE
Last Name:NASH BEYER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SERVICE AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1014
Mailing Address - Country:US
Mailing Address - Phone:401-767-4100
Mailing Address - Fax:401-235-6833
Practice Address - Street 1:450 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3207
Practice Address - Country:US
Practice Address - Phone:401-767-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-19
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW030921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27AC169F-10AD-4036-BOtherCANS ADMINISTRATOR