Provider Demographics
NPI:1538438643
Name:GAYE C. BEATTY, LLC
Entity type:Organization
Organization Name:GAYE C. BEATTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:GAYE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:610-434-0962
Mailing Address - Street 1:3612 LENAIRE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1216
Mailing Address - Country:US
Mailing Address - Phone:610-419-4190
Mailing Address - Fax:
Practice Address - Street 1:501 N 17TH ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5044
Practice Address - Country:US
Practice Address - Phone:610-434-0962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001507-L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA645751OtherMEDICARE PROVIDER NUMBER