Provider Demographics
NPI:1326377441
Name:BEAUFORD, COREY DARNELL (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:DARNELL
Last Name:BEAUFORD
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 TAYLOR ROAD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2049
Mailing Address - Country:US
Mailing Address - Phone:301-877-3721
Mailing Address - Fax:
Practice Address - Street 1:5600 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2000
Practice Address - Country:US
Practice Address - Phone:301-877-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-19
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222281041C0700X
DCLC500786491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty