Provider Demographics
NPI:1194867432
Name:BEECROFT, MARLENE ANN (MSSW, LICSW)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:ANN
Last Name:BEECROFT
Suffix:
Gender:F
Credentials:MSSW, LICSW
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:ANN
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1930 COON RAPIDS BOULEVARD
Mailing Address - Street 2:FAMILY LIFE MENTAL HEALTH CENTER
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:763-427-7964
Mailing Address - Fax:763-427-7976
Practice Address - Street 1:1930 COON RAPIDS BOULEVARD
Practice Address - Street 2:FAMILY LIFE MENTAL HEALTH CENTER
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-427-7964
Practice Address - Fax:763-427-7976
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP017241041C0700X
MN01724104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN150322OtherU-CARE
MNHP30584OtherHEALTH PARTNERS
MN6C871BEOtherBCBS OF MN
MN1011797OtherPREFERRED ONE
MN472357100Medicaid
MN472357100Medicaid