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General NPI Number Information
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NPI Number | 1992034748
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Entity Type | Organization
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Legal Business Name | BETH VARDARO LCSW PC
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 341 LINKS DR E
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City | OCEANSIDE
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State | NY
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Zip | 11572-5624
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Country | US
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Telephone | 516-678-1796
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Fax | 516-678-1796
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Provider Business Mailing Address
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Address Line | 341 LINKS DR E
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City | OCEANSIDE
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State | NY
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Zip | 11572-5624
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Country | US
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Telephone | 516-678-1796
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Fax | 516-678-1796
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BETH VARDARO
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Credential | LCSW
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Telephone | 516-678-1796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | R-052901-1
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License Number State | NY
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