Healthcare Provider Details

I. General information

NPI: 1417010018
Provider Name (Legal Business Name): ELFRIEDE MARGOT WEISS-PAQUETTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD BUILDING 71, SECOND FLOOR
W BRENTWOOD NY
11717-1043
US

IV. Provider business mailing address

181 OAKLAND AVE
MILLER PLACE NY
11764-3407
US

V. Phone/Fax

Practice location:
  • Phone: 631-951-2209
  • Fax: 631-951-2209
Mailing address:
  • Phone: 631-821-1459
  • Fax: 631-821-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0296511
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: