Healthcare Provider Details

I. General information

NPI: 1659118958
Provider Name (Legal Business Name): MARIA JOSE BELTRAN CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 WATERBURY AVE
BRONX NY
10462-5017
US

IV. Provider business mailing address

2226 WESTERVELT AVE # 1
BRONX NY
10469-6418
US

V. Phone/Fax

Practice location:
  • Phone: 347-340-4099
  • Fax:
Mailing address:
  • Phone: 347-340-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P131999-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number38804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: