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:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BEAUREGARD-WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-470-0284
Mailing Address - Street 1:139 ARDSLEY ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1611
Mailing Address - Country:US
Mailing Address - Phone:917-470-0284
Mailing Address - Fax:178-351-4786
Practice Address - Street 1:139 ARDSLEY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1611
Practice Address - Country:US
Practice Address - Phone:917-470-0284
Practice Address - Fax:178-351-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050794261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02455636Medicaid