Healthcare Provider Details

I. General information

NPI: 1407469687
Provider Name (Legal Business Name): VICTORIA BEAURY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA PRISK LMSW

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98120 QUEENS BLVD STE 1C
REGO PARK NY
11374-4414
US

IV. Provider business mailing address

14924 11TH AVE
WHITESTONE NY
11357-1721
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax:
Mailing address:
  • Phone: 516-640-9672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: