Provider Demographics
NPI:1164286670
Name:NELLIGAN, BETHANY LEIGH (LMHC, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LEIGH
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2810
Mailing Address - Country:US
Mailing Address - Phone:716-512-9195
Mailing Address - Fax:
Practice Address - Street 1:3937 YALE AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2810
Practice Address - Country:US
Practice Address - Phone:716-512-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009318-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty