Provider Demographics
NPI:1891186029
Name:MARIE BEAUREGARD-WEISS, LCSW,PC
Entity type:Organization
Organization Name:MARIE BEAUREGARD-WEISS, LCSW,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUREGARD-WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-470-0284
Mailing Address - Street 1:10501 WOODLAND WATERS BLVD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6410
Mailing Address - Country:US
Mailing Address - Phone:917-470-0284
Mailing Address - Fax:178-351-4786
Practice Address - Street 1:2078 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3916
Practice Address - Country:US
Practice Address - Phone:917-470-0284
Practice Address - Fax:352-293-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02455636Medicaid