1245349950 NPI number — MS. BEVERLY L NELSON LCSW BCD

Table of content: MS. BEVERLY L NELSON LCSW BCD (NPI 1245349950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245349950 NPI number — MS. BEVERLY L NELSON LCSW BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
BEVERLY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245349950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8010 RIDGE RD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-288-7242
Provider Business Mailing Address Fax Number:
804-288-7243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8010 RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-288-7242
Provider Business Practice Location Address Fax Number:
804-288-7243
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904000709 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 32329 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6216760 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: NG521 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080282 . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132042 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5781127 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6280001 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 692862 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 179351 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 127542 . This is a "GREEN SPRING" identifier . This identifiers is of the category "OTHER".
  • Identifier: 167945 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8906220 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 230847 . This is a "TRIGON" identifier . This identifiers is of the category "OTHER".




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