Provider Demographics
NPI:1285404616
Name:WEEDON, EMMA LOUISE (MHC-LP)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:LOUISE
Last Name:WEEDON
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 34TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1765
Mailing Address - Country:US
Mailing Address - Phone:516-582-8802
Mailing Address - Fax:
Practice Address - Street 1:3117 34TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1765
Practice Address - Country:US
Practice Address - Phone:516-582-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP126120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health