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General NPI Number Information
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NPI Number | 1265414379
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Entity Type | Individual
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Provider Name | BETH WIDZOWSKI LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 1512 WANTAGH AVE SOUTH SHORE COUNSELING
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City | WANTAGH
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State | NY
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Zip | 11793-2216
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Country | US
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Telephone | 516-785-0323
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Fax | 516-785-6026
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Provider Business Mailing Address
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Address Line | 33 RANDY LN
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City | PLAINVIEW
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State | NY
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Zip | 11803-3942
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Country | US
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Telephone | 516-938-3112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9516
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License Number State | FL
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