Individual
BETHANY MARIE TY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
77 BYSTREK DR, MIDDLETOWN, CT 06457-8706
(203) 500-8445
Mailing address
77 BYSTREK DR, MIDDLETOWN, CT 06457-8706
(203) 500-8445
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13361
CT
Other
Enumeration date
02/10/2025
Last updated
02/10/2025
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