Provider Demographics
NPI:1053959882
Name:SCARLETT BEGONIAS, LLC
Entity type:Organization
Organization Name:SCARLETT BEGONIAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CASAC-2
Authorized Official - Phone:914-705-3538
Mailing Address - Street 1:25 MARTINE AVE APT 911
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-4023
Mailing Address - Country:US
Mailing Address - Phone:914-719-6829
Mailing Address - Fax:305-647-0680
Practice Address - Street 1:25 MARTINE AVE APT 911
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-4023
Practice Address - Country:US
Practice Address - Phone:914-719-6829
Practice Address - Fax:305-647-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty