Provider Demographics
NPI:1265414379
Name:WIDZOWSKI, BETH (LCSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:WIDZOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RANDY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3942
Mailing Address - Country:US
Mailing Address - Phone:516-938-3112
Mailing Address - Fax:
Practice Address - Street 1:1512 WANTAGH AVE
Practice Address - Street 2:SOUTH SHORE COUNSELING
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2216
Practice Address - Country:US
Practice Address - Phone:516-785-0323
Practice Address - Fax:516-785-6026
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW95161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N3K081Medicare ID - Type Unspecified