Provider Demographics
NPI:1265573455
Name:BEYNOR, DOLORES M (LCSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:M
Last Name:BEYNOR
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 LAKE JOSEPHINE DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-6411
Mailing Address - Country:US
Mailing Address - Phone:863-655-4468
Mailing Address - Fax:
Practice Address - Street 1:1346 US 27 N
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-7950
Practice Address - Country:US
Practice Address - Phone:863-699-4357
Practice Address - Fax:863-465-3040
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW34401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6368Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
FLZ6368WMedicare PIN