1851688170 NPI number — MRS. ELISABETH ANNE BEARDSLEY MSW, LICSW

Table of content: MRS. ELISABETH ANNE BEARDSLEY MSW, LICSW (NPI 1851688170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851688170 NPI number — MRS. ELISABETH ANNE BEARDSLEY MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEARDSLEY
Provider First Name:
ELISABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEARDSLEY
Provider Other First Name:
ELISABETH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851688170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 CODY DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCA
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25159-9035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-881-1678
Provider Business Mailing Address Fax Number:
800-796-4730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 CODY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCA
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25159-9035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-881-1678
Provider Business Practice Location Address Fax Number:
800-796-4730
Provider Enumeration Date:
07/07/2011

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:  DP00942941 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DP00942941 . This is a "INDEPENDENT CLINICAL SOCIAL WORK LICENSE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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