Provider Demographics
NPI:1598510208
Name:BEECHAM-JOSEPH, PRISCILLA (LCSW)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:BEECHAM-JOSEPH
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 1:431 RACHEL CIR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5150
Mailing Address - Country:US
Mailing Address - Phone:312-813-8403
Mailing Address - Fax:
Practice Address - Street 1:431 RACHEL CIR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-5150
Practice Address - Country:US
Practice Address - Phone:312-813-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IL149026952104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker