Provider Demographics
NPI:1518376953
Name:BEALS, PHYLLIS EGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:EGAN
Last Name:BEALS
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 1:6 ALMA CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7371
Mailing Address - Country:US
Mailing Address - Phone:732-331-3416
Mailing Address - Fax:732-545-2321
Practice Address - Street 1:6 ALMA CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-7371
Practice Address - Country:US
Practice Address - Phone:732-331-3416
Practice Address - Fax:732-545-2321
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005277001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical