Healthcare Provider Details

I. General information

NPI: 1487647178
Provider Name (Legal Business Name): ARTHUR BECKER-WEIDMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 MAIN ST SUITE 406
WILLIAMSVILLE NY
14221-5776
US

IV. Provider business mailing address

6 EMERALD TRL
WILLIAMSVILLE NY
14221-8305
US

V. Phone/Fax

Practice location:
  • Phone: 716-810-0790
  • Fax: 716-636-6243
Mailing address:
  • Phone: 716-810-0790
  • Fax: 716-636-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11832
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105983
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number054696-R
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: