Healthcare Provider Details

I. General information

NPI: 1497852818
Provider Name (Legal Business Name): SUSAN ANN BECKER-WEIDMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 MAIN ST STE 406
WILLIAMSVILLE NY
14221-5734
US

IV. Provider business mailing address

5820 MAIN ST STE 406
WILLIAMSVILLE NY
14221-5734
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 TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR057251-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: