Provider Demographics
NPI:1922317668
Name:BEENEN, SELINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SELINA
Middle Name:
Last Name:BEENEN
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 1:2347 BAREFOOT TRCE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-6604
Mailing Address - Country:US
Mailing Address - Phone:904-612-8807
Mailing Address - Fax:
Practice Address - Street 1:4300 MARSH LANDING BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-1416
Practice Address - Country:US
Practice Address - Phone:904-612-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW100431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical