1710057476 NPI number — MR. DANIEL RICHARD BEATTY LCSW

Table of content: MR. DANIEL RICHARD BEATTY LCSW (NPI 1710057476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710057476 NPI number — MR. DANIEL RICHARD BEATTY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEATTY
Provider First Name:
DANIEL
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEATTY
Provider Other First Name:
DANIEL
Provider Other Middle Name:
RICHARD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710057476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219A AVERY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655-3102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-430-8344
Provider Business Mailing Address Fax Number:
828-430-4384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219A AVERY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-430-8344
Provider Business Practice Location Address Fax Number:
828-430-4384
Provider Enumeration Date:
11/09/2006

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: 104100000X , with the licence number:  C004809 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C004809 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6003109 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com