Provider Demographics
NPI:1477927937
Name:WEATHERSTON, DEIRDRE M (MSED, RBT, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:M
Last Name:WEATHERSTON
Suffix:
Gender:F
Credentials:MSED, RBT, BCBA, LBA
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:M
Other - Last Name:CLANCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, RBT, BCBA, LBA
Mailing Address - Street 1:351 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3205
Mailing Address - Country:US
Mailing Address - Phone:917-882-0429
Mailing Address - Fax:
Practice Address - Street 1:351 DOVER ST
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3205
Practice Address - Country:US
Practice Address - Phone:917-882-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-20674103K00000X
NY1196103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst