Provider Demographics
NPI:1598779480
Name:VON WATZDORF, BEATRIX M (MS, MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:BEATRIX
Middle Name:M
Last Name:VON WATZDORF
Suffix:
Gender:F
Credentials:MS, MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2884 GALLOWS HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIEGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18077-9737
Mailing Address - Country:US
Mailing Address - Phone:484-817-1220
Mailing Address - Fax:
Practice Address - Street 1:3201 ROUTE 212
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:18081
Practice Address - Country:US
Practice Address - Phone:202-309-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003665101YP2500X
DCPRC13894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional