Fernando Edgardo Beltran Jr.
Social Worker, Clinical in Port Jefferson Station, NY. Individual provider (NPI-1).
NPI number1164035200
StatusActive
Last updated in NPPESOct 1, 2023
Details
- NPI
- 1164035200
- Entity type
- Individual (NPI-1)
- Name
- Mr. Fernando Edgardo Beltran Jr.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 28, 2020
- Certification date
- Oct 1, 2023
- Last updated
- Oct 1, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 093837-01 | NY | Yes |
| 104100000X | Social Worker | 101668-01 | NY |
Practice location
425 Old Town RdPort Jefferson Station, NY 11776-3627
Phone 631-209-7042
Mailing address
425 Old Town RdPort Jefferson Station, NY 11776-3627
Phone 631-209-7042
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