Provider Demographics
NPI:1962590422
Name:BEAL, RONALD JUSTIN (BCD LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JUSTIN
Last Name:BEAL
Suffix:
Gender:M
Credentials:BCD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 WESTRIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1148
Mailing Address - Country:US
Mailing Address - Phone:814-444-9696
Mailing Address - Fax:814-444-0345
Practice Address - Street 1:445 WESTRIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1148
Practice Address - Country:US
Practice Address - Phone:814-444-9696
Practice Address - Fax:814-444-0345
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0126831041C0700X, 101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101924967 0002Medicaid
PA101155683Medicaid
PA1019249670002Medicaid
PA1011556830002Medicaid
PA260606OtherBLUE CROSS BLUE SHIELD
PA101155683Medicaid