Provider Demographics
NPI:1124455878
Name:WEIDBERG, SHARON ELISE (SEIT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELISE
Last Name:WEIDBERG
Suffix:
Gender:F
Credentials:SEIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 RYDER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-2224
Mailing Address - Country:US
Mailing Address - Phone:718-755-0216
Mailing Address - Fax:
Practice Address - Street 1:83 RYDER AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2224
Practice Address - Country:US
Practice Address - Phone:718-755-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY492978041103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst