Provider Demographics
NPI:1194351452
Name:MYERS-BEACHAM, VICTORIA ANTONIA (LICSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANTONIA
Last Name:MYERS-BEACHAM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57A CONN ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-5661
Mailing Address - Country:US
Mailing Address - Phone:610-657-2895
Mailing Address - Fax:
Practice Address - Street 1:75 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2763
Practice Address - Country:US
Practice Address - Phone:978-774-7566
Practice Address - Fax:978-774-4389
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker