MEDICARE: BEACON COUNSELING LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1710856315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON COUNSELING LCSW PLLC

Provider Business Mailing Address
First Line	:	PO BOX 854
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-0854
Country	:	US
Telephone Number	:	516-522-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 JORDAN CT
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-8319
Country	:	US
Telephone Number	:	516-522-0096
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDEN ALTHAUS
Credential	:	LCSW
Telephone Number	:	516-522-0096

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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