| Marie Beauregard-weiss, Lcsw,pc | |
|
2078 Richmond Ave Staten Island NY 10314-3916 | |
| (917) 470-0284 | |
| (352) 293-3137 |
| Full Name | Marie Beauregard-weiss, Lcsw,pc |
|---|---|
| Speciality | Social Worker |
| Location | 2078 Richmond Ave, Staten Island, New York |
| Authorized Official Name and Position | Marie Beauregard-weiss (PROVIDER ADMINISTRATOR) |
| Authorized Official Contact | 9174700284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marie Beauregard-weiss, Lcsw,pc 10501 Woodland Waters Blvd Weeki Wachee FL 34613-6410 Ph: (917) 470-0284 | Marie Beauregard-weiss, Lcsw,pc 2078 Richmond Ave Staten Island NY 10314-3916 Ph: (917) 470-0284 |
| NPI Number | 1891186029 |
|---|---|
| Provider Enumeration Date | 02/10/2015 |
| Last Update Date | 12/09/2024 |
| Certification Date | 12/09/2024 |
| Medicare PECOS PAC ID | 7012235724 |
|---|---|
| Medicare Enrollment ID | O20240513002565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891186029 | NPI | - | NPPES |
| 02455636 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Marie C Beauregard-weiss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134217508 PECOS PAC ID: 9436122256 Enrollment ID: I20240513002817 |
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