Provider Demographics
NPI:1649293002
Name:BEASLEY, KEVIN S (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:S
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BROOM RD
Mailing Address - Street 2:
Mailing Address - City:LAKENHEATH
Mailing Address - State:UNITED KINGDOM
Mailing Address - Zip Code:IP279ES
Mailing Address - Country:GB
Mailing Address - Phone:01-144-1638
Mailing Address - Fax:
Practice Address - Street 1:PSC 37 BOX 2674
Practice Address - Street 2:
Practice Address - City:APO AE
Practice Address - State:UNITED KINGDOM
Practice Address - Zip Code:09459
Practice Address - Country:GB
Practice Address - Phone:01144
Practice Address - Fax:528070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW33051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical