Provider Demographics
NPI:1134732472
Name:BEARD, AMY SUSAN (LCSW, MSW, JD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUSAN
Last Name:BEARD
Suffix:
Gender:F
Credentials:LCSW, MSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SW ALDER ST APT 316
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1950
Mailing Address - Country:US
Mailing Address - Phone:917-595-9094
Mailing Address - Fax:
Practice Address - Street 1:1625 SW ALDER ST APT 316
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1950
Practice Address - Country:US
Practice Address - Phone:971-500-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA5950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health