Provider Demographics
NPI:1275663569
Name:KING, BEVERLY JO (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JO
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S BRADFORD ST
Mailing Address - Street 2:STE #8
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4153
Mailing Address - Country:US
Mailing Address - Phone:302-678-3480
Mailing Address - Fax:302-734-3299
Practice Address - Street 1:1001 S BRADFORD ST
Practice Address - Street 2:STE #8
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:302-678-3480
Practice Address - Fax:302-734-3299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00006591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035484Medicaid
DE492030Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
DE1000035484Medicaid