Healthcare Provider Details

I. General information

NPI: 1932945409
Provider Name (Legal Business Name): MARIE BEAUREGARD WEISS LCSW PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 WOODLAND WATERS BLVD
WEEKI WACHEE FL
34613-6410
US

IV. Provider business mailing address

10501 WOODLAND WATERS BLVD
WEEKI WACHEE FL
34613-6410
US

V. Phone/Fax

Practice location:
  • Phone: 917-470-0284
  • Fax: 352-293-3137
Mailing address:
  • Phone: 917-470-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARIE BEAUREGARD-WEISS
Title or Position: PROVIDER/ADMINISTRATOR
Credential: LCSW
Phone: 917-470-0284