Individual
BETHANY THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
99 ALMADEN BLVD STE 600, SAN JOSE, CA 95113-6489
(707) 527-2064
Mailing address
PO BOX 7614, NEWARK, DE 19714-7614
(484) 602-9681
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
ASW59950
CA
1041C0700X
Clinical Social Worker
Primary
90745
CA
Other
Enumeration date
07/14/2014
Last updated
09/09/2023
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