Provider Demographics
NPI:1275892143
Name:BEATTY, MICHAEL THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:BEATTY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTHPOINTE CIR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7851
Mailing Address - Country:US
Mailing Address - Phone:724-772-4848
Mailing Address - Fax:724-772-4888
Practice Address - Street 1:100 NORTHPOINTE CIR
Practice Address - Street 2:SUITE 306
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7851
Practice Address - Country:US
Practice Address - Phone:724-772-4848
Practice Address - Fax:724-772-4888
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0177701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical