Provider Demographics
NPI:1518283266
Name:WEYLER, AUDREY R (MHC)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:R
Last Name:WEYLER
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 3RD STREET
Mailing Address - Street 2:APARTMENT 2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2839
Mailing Address - Country:US
Mailing Address - Phone:954-305-7303
Mailing Address - Fax:
Practice Address - Street 1:130 W 42ND ST
Practice Address - Street 2:SUITE 1805
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7902
Practice Address - Country:US
Practice Address - Phone:954-305-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH 884101YM0800X
NYP87456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health