Provider Demographics
NPI:1992034748
Name:BETH VARDARO LCSW PC
Entity Type:Organization
Organization Name:BETH VARDARO LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDARO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-678-1796
Mailing Address - Street 1:341 LINKS DR E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5624
Mailing Address - Country:US
Mailing Address - Phone:516-678-1796
Mailing Address - Fax:516-678-1796
Practice Address - Street 1:341 LINKS DR E
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5624
Practice Address - Country:US
Practice Address - Phone:516-678-1796
Practice Address - Fax:516-678-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-052901-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02537864Medicaid
NY02537864Medicaid