Provider Demographics
NPI:1518268291
Name:BEUER, JENNIE LYNN (LCSW, MSW, RPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:LYNN
Last Name:BEUER
Suffix:
Gender:F
Credentials:LCSW, MSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 PONDELLA RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4340
Mailing Address - Country:US
Mailing Address - Phone:239-652-0260
Mailing Address - Fax:
Practice Address - Street 1:390 PONDELLA RD
Practice Address - Street 2:SUITE 9
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4340
Practice Address - Country:US
Practice Address - Phone:239-652-0260
Practice Address - Fax:239-652-0146
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99230041041C0700X
FLSW116981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL805167Medicaid