Provider Demographics
NPI:1821049792
Name:BEEBE, JONATHAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BEEBE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1144
Mailing Address - Country:US
Mailing Address - Phone:718-461-2755
Mailing Address - Fax:914-632-2940
Practice Address - Street 1:6120 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3557
Practice Address - Country:US
Practice Address - Phone:718-779-1234
Practice Address - Fax:718-779-7775
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0720421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY072042OtherNY LCSW LICENSE #
NY1285628552OtherJDAM NPI
NY00355940Medicaid
NY1285628552OtherJDAM NPI