Fernando Edgardo Beltran Jr.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

093837-01 Issued in NY

Practice address

425 Old Town Rd
Port Jefferson Station, NY 11776-3627

Phone

(631) 209-7042

NPI assigned

Aug 28, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Changing Seasons Counseling LCSW PLLC

  • Clinical Social Worker
  • Port Jefferson Station, NY
  • NPI 1316646607
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696118400000",
    "number": "1164035200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 OLD TOWN RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763627",
            "telephone_number": "631-209-7042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 OLD TOWN RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763627",
            "telephone_number": "631-209-7042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELTRAN",
        "first_name": "FERNANDO",
        "middle_name": "EDGARDO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-28",
        "last_updated": "2023-10-01",
        "certification_date": "2023-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "101668-01",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "093837-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophie Farah Beausoleil
• Brandi Beere, NP
• Karen Lynn Behrman
• Melissa A Bello, LPN
• Genna Belluardo
• Shannon Emily Berg I
• Angelina C Bergano
• Anne Marie Berggren, RDN, CNSC
• Rebekah Berin
• Elyssa Bernstein, D.D.S.

• Clinical Social Worker in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.