Provider Demographics
NPI:1740644244
Name:BEGENTLE PSYCHOTHERAPY, NP IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:BEGENTLE PSYCHOTHERAPY, NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PIERRETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEGENT
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:631-834-6356
Mailing Address - Street 1:122 W ROE BLVD
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2569
Mailing Address - Country:US
Mailing Address - Phone:631-834-6356
Mailing Address - Fax:631-627-8533
Practice Address - Street 1:122 W ROE BLVD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2569
Practice Address - Country:US
Practice Address - Phone:631-834-6356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401855-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300134634Medicare PIN