Provider Demographics
NPI:1982752754
Name:WOOGEN, BETH - (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:-
Last Name:WOOGEN
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:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:CROMPOND
Mailing Address - State:NY
Mailing Address - Zip Code:10517-0085
Mailing Address - Country:US
Mailing Address - Phone:914-528-1420
Mailing Address - Fax:914-528-2355
Practice Address - Street 1:20 PAULDING LA.
Practice Address - Street 2:
Practice Address - City:CROMPOND
Practice Address - State:NY
Practice Address - Zip Code:10517-0085
Practice Address - Country:US
Practice Address - Phone:914-528-1420
Practice Address - Fax:914-528-2355
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR022014-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNF6401Medicare ID - Type UnspecifiedCLINICAL SOC. WKR.