Individual
MR. BYRON FRANK BEALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, BCBA
Contact information
Practice address
96100 HIDDEN MARSH LN, FERNANDINA BEACH, FL 32034-1656
(904) 556-2169
Mailing address
96100 HIDDEN MARSH LN, FERNANDINA BEACH, FL 32034-1656
(904) 556-2169
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1010451
FL
104100000X
Social Worker
5260
FL
1041C0700X
Clinical Social Worker
5260
FL
1041C0700X
Clinical Social Worker
Primary
SW5260
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
692499996
MEDICAID WAIVER
FL
01
—
692499998
MEDICAID WAIVER
FL
Enumeration date
04/19/2010
Last updated
02/10/2021
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