Kelvette Beacham, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L1500524 Issued in OH

Practice address

5010 Mayfield Rd Ste 210
Lyndhurst, OH 44124-2692

Phone

(216) 831-2255

Fax

(216) 378-3906

NPI assigned

Mar 20, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Life Bridge Therapy Services LLC

  • Mental Health Counselor
  • Lyndhurst, OH
  • NPI 1811510308
  Medicare reassignment NPD Authorized official
• Beech Brook

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cleveland, OH
  • NPI 1437399474
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1497097125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26151 LAKE SHORE BLVD APT 1409W",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441321156",
            "telephone_number": "216-533-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5010 MAYFIELD RD STE 210",
            "city": "LYNDHURST",
            "state": "OH",
            "postal_code": "441242692",
            "telephone_number": "216-831-2255",
            "fax_number": "216-378-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEACHAM",
        "first_name": "KELVETTE",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-20",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S.0901415",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "L1500524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2871101",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan K. Bailey, D.O.
• John Ball, D.D.S.
• Kathryn Barringer
• Barry a Koblentz DPM Inc
• Christine Baucco, ATC
• Beachwood OB GYN Inc
• Sarah Elizabeth Belisle, OTR/L
• Sandra L Bellin, MD
• Regina Bennetts
• Ashley Berk

• Clinical Social Worker in Lyndhurst, OH
• Providers in Lyndhurst, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.