Provider Demographics
NPI:1225572845
Name:BETHEA, UNIQUE
Entity Type:Individual
Prefix:
First Name:UNIQUE
Middle Name:
Last Name:BETHEA
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 1:365 E 184TH ST APT 809
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-7419
Mailing Address - Country:US
Mailing Address - Phone:917-771-8668
Mailing Address - Fax:
Practice Address - Street 1:365 E 184TH ST APT 809
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-7419
Practice Address - Country:US
Practice Address - Phone:917-771-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst