Provider Demographics
NPI:1396090098
Name:BEYER, CAROL A (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:BEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 ELMSFORD DR
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3351
Mailing Address - Country:US
Mailing Address - Phone:716-675-5505
Mailing Address - Fax:
Practice Address - Street 1:2813 WEHRLE DR STE 11
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7384
Practice Address - Country:US
Practice Address - Phone:716-249-4706
Practice Address - Fax:716-634-0746
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079250-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY173540453Medicaid