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General NPI Number Information
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NPI Number | 1891186029
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Entity Type | Organization
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Legal Business Name | MARIE BEAUREGARD-WEISS, LCSW,PC
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2078 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3916
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Country | US
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Telephone | 917-470-0284
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Fax | 352-293-3137
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Provider Business Mailing Address
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Address Line | 10501 WOODLAND WATERS BLVD
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-6410
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Country | US
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Telephone | 917-470-0284
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Fax | 178-351-4786
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Authorized Official
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Title or Position | PROVIDER ADMINISTRATOR
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Name | MARIE BEAUREGARD-WEISS
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Credential | LCSW
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Telephone | 917-470-0284
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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 |
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License Number State |
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