Provider Demographics
NPI:1982427308
Name:WEINER, BETH AUDREY (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:AUDREY
Last Name:WEINER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PEARL ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4611
Mailing Address - Country:US
Mailing Address - Phone:845-279-5908
Mailing Address - Fax:
Practice Address - Street 1:10 PEARL ST FL 2
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4611
Practice Address - Country:US
Practice Address - Phone:845-279-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical