Healthcare Provider Details

I. General information

NPI: 1902891716
Provider Name (Legal Business Name): JOAN C BEDER JOAN BEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN BEDER JOAN BEDER

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HICKS LN
OLD WESTBURY NY
11568-1618
US

IV. Provider business mailing address

30 HICKS LN
OLD WESTBURY NY
11568-1618
US

V. Phone/Fax

Practice location:
  • Phone: 516-997-8326
  • Fax:
Mailing address:
  • Phone: 516-997-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR025825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: