Provider Demographics
NPI:1255820643
Name:BEVENEY, MINA LANI (PHD, LCSW, MSW, MED)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:LANI
Last Name:BEVENEY
Suffix:
Gender:F
Credentials:PHD, LCSW, MSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 THE GREEN, SUITE 8392
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:484-361-4611
Mailing Address - Fax:
Practice Address - Street 1:8 THE GREEN, SUITE 8392
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:484-361-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
DEQ1-00118241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ1-0011824OtherDIVISION OF PROFESSIONAL REGULATION