Provider Demographics
NPI:1316646607
Name:CHANGING SEASONS COUNSELING LCSW PLLC
Entity type:Organization
Organization Name:CHANGING SEASONS COUNSELING LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-575-3435
Mailing Address - Street 1:425 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3627
Mailing Address - Country:US
Mailing Address - Phone:631-209-7042
Mailing Address - Fax:
Practice Address - Street 1:425 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3627
Practice Address - Country:US
Practice Address - Phone:631-209-7042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty