Provider Demographics
NPI:1487722336
Name:WEINSTEIN, BEVERLY A (LCSW)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:WEINSTEIN
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 1:180 W END AVE
Mailing Address - Street 2:170 WEST END AVENUE SUITE 1K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4902
Mailing Address - Country:US
Mailing Address - Phone:212-874-3415
Mailing Address - Fax:212-580-6028
Practice Address - Street 1:180 W END AVE
Practice Address - Street 2:170 WEST END AVE.SUITE 1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4902
Practice Address - Country:US
Practice Address - Phone:212-874-3415
Practice Address - Fax:212-580-6028
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0012141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN22S61Medicare ID - Type Unspecified