| Kelvette Beacham, LISW | |
|
5010 Mayfield Rd Ste 210, Lyndhurst, OH 44124-2692 | |
| (216) 831-2255 | |
| (216) 378-3906 |
| Full Name | Kelvette Beacham |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 5010 Mayfield Rd Ste 210, Lyndhurst, Ohio |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497097125 | NPI | - | NPPES |
| 2871101 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | S.0901415 (Ohio) | Secondary |
| 1041C0700X | Social Worker - Clinical | L1500524 (Ohio) | Primary |
| Entity Name | Life Bridge Therapy Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1811510308 PECOS PAC ID: 2668891847 Enrollment ID: O20201008000325 |
| Mailing Address | Practice Location Address |
|---|---|
| Kelvette Beacham, LISW 26151 Lake Shore Blvd Apt 1409w, Euclid, OH 44132-1156 Ph: (216) 533-2614 | Kelvette Beacham, LISW 5010 Mayfield Rd Ste 210, Lyndhurst, OH 44124-2692 Ph: (216) 831-2255 |
Yaasmeen Siddeeqa Muslima Ibrahim, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 5010 Mayfield Rd Ste 210, Lyndhurst, OH 44124 Phone: 216-505-4774 | |
Mr. Lance Taylor Peterson, LISW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1551 Commodore Rd, Lyndhurst, OH 44124 Phone: 216-544-4407 | |
Kayla Koyfman, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 5010 Mayfield Rd Ste 306, Lyndhurst, OH 44124 Phone: 216-591-6191 | |
Ms. Kathleen Usaj, LISW-S Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1950 Richmond Rd, Lyndhurst, OH 44124 Phone: 216-448-8608 | |
Mr. Scott A Whipple, LCSW, ACSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 5281 Dogwood Trl, Lyndhurst, OH 44124 Phone: 917-570-0053 | |
Suzanne Harrington, LISW Clinical Social Worker Medicare: May Accept Medicare Assignments Practice Location: 5010 Mayfield Rd Ste 105, Lyndhurst, OH 44124 Phone: 216-970-5404 |