Provider Demographics
NPI:1003064676
Name:HUMBERT, BETH ANNE
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANNE
Last Name:HUMBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 EASTBURY AVE NE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2136
Mailing Address - Country:US
Mailing Address - Phone:330-316-5519
Mailing Address - Fax:330-494-8064
Practice Address - Street 1:503 EASTBURY AVE NE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2136
Practice Address - Country:US
Practice Address - Phone:330-316-5519
Practice Address - Fax:330-494-8064
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator