Provider Demographics
NPI:1891046991
Name:BEAMAN, STEPHEN DOUGLAS (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:BEAMAN
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 1:1021 N MULFORD RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3877
Mailing Address - Country:US
Mailing Address - Phone:815-399-9700
Mailing Address - Fax:815-394-1401
Practice Address - Street 1:1021 N MULFORD RD
Practice Address - Street 2:SUITE #1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3877
Practice Address - Country:US
Practice Address - Phone:815-399-9700
Practice Address - Fax:815-394-1401
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0074241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical