Provider Demographics
NPI:1538712930
Name:WERDEL, MARY BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY BETH
Middle Name:
Last Name:WERDEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2418
Mailing Address - Country:US
Mailing Address - Phone:603-661-4068
Mailing Address - Fax:
Practice Address - Street 1:172 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-1954
Practice Address - Country:US
Practice Address - Phone:800-317-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007537-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health