Provider Demographics
NPI:1699925792
Name:WALDO, BETH AILENE (LCSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:AILENE
Last Name:WALDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 KAYLEEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7030
Mailing Address - Country:US
Mailing Address - Phone:845-565-8447
Mailing Address - Fax:
Practice Address - Street 1:10 KAYLEEN DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-0000
Practice Address - Country:US
Practice Address - Phone:845-565-8447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0181493-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical