Provider Demographics
NPI:1467535179
Name:BEIM, JETTY (LCSW)
Entity Type:Individual
Prefix:
First Name:JETTY
Middle Name:
Last Name:BEIM
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 1:41 ELM ST APT 1G
Mailing Address - Street 2:41 ELM STREET, SUITE 1G
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7205
Mailing Address - Country:US
Mailing Address - Phone:973-644-2520
Mailing Address - Fax:973-644-2220
Practice Address - Street 1:41 ELM STREET,
Practice Address - Street 2:SUITE 1G
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7205
Practice Address - Country:US
Practice Address - Phone:973-644-2520
Practice Address - Fax:973-644-2220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004403001041C0700X
NYR029107-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ638840Medicare ID - Type Unspecified