Provider Demographics
NPI:1134645385
Name:NASH BEYER, DARNELL DALE (LICSW)
Entity type:Individual
Prefix:MR
First Name:DARNELL
Middle Name:DALE
Last Name:NASH BEYER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-1940
Mailing Address - Country:US
Mailing Address - Phone:401-263-5447
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 267
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-714-0996
Practice Address - Fax:510-844-3385
Is Sole Proprietor?:No
Enumeration Date:2017-08-19
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW030921041C0700X
CA1106981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27AC169F-10AD-4036-BOtherCANS ADMINISTRATOR