Provider Demographics
NPI:1174573331
Name:VAN BEUSEKOM, JANNEKE M (LCSW)
Entity type:Individual
Prefix:
First Name:JANNEKE
Middle Name:M
Last Name:VAN BEUSEKOM
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 1:822 MARIETTA AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3239
Mailing Address - Country:US
Mailing Address - Phone:717-393-3002
Mailing Address - Fax:
Practice Address - Street 1:822 MARIETTA AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3239
Practice Address - Country:US
Practice Address - Phone:717-393-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03157501OtherCAPITAL BLUE CROSS
PA464460OtherVALUE OPTIONS
PA03157501OtherCAPITAL BLUE CROSS