1467535179 NPI number — JETTY BEIM LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467535179 NPI number — JETTY BEIM LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEIM
Provider First Name:
JETTY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1467535179
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:
41 ELM ST APT 1G
Provider Second Line Business Mailing Address:
41 ELM STREET, SUITE 1G
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-7205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-644-2520
Provider Business Mailing Address Fax Number:
973-644-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 ELM STREET,
Provider Second Line Business Practice Location Address:
SUITE 1G
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-7205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-644-2520
Provider Business Practice Location Address Fax Number:
973-644-2220
Provider Enumeration Date:
10/24/2006

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:  44SC00440300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: R029107-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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