Provider Demographics
NPI:1144415894
Name:BEITER, MARY (LCSW-R)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BEITER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2915
Mailing Address - Country:US
Mailing Address - Phone:716-545-0314
Mailing Address - Fax:716-856-2005
Practice Address - Street 1:552 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2915
Practice Address - Country:US
Practice Address - Phone:165-450-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046064-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical