Provider Demographics
NPI:1932463304
Name:BEATTIE, JAMES MATTHEW (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MATTHEW
Last Name:BEATTIE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 47TH AVE
Mailing Address - Street 2:APT. 5B
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5663
Mailing Address - Country:US
Mailing Address - Phone:917-710-2138
Mailing Address - Fax:
Practice Address - Street 1:8956 162ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5072
Practice Address - Country:US
Practice Address - Phone:917-710-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079979104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker