Provider Demographics
NPI:1093084097
Name:RICKARD, BETHANY ANN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:ANN
Last Name:RICKARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:ORISKANY FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13425-3621
Mailing Address - Country:US
Mailing Address - Phone:315-404-5021
Mailing Address - Fax:
Practice Address - Street 1:106 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4818
Practice Address - Country:US
Practice Address - Phone:315-368-6767
Practice Address - Fax:315-792-2187
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083189-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool