Provider Demographics
NPI:1265864664
Name:STEIN, BETHANY (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LDN
Mailing Address - Street 1:149 HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3964
Mailing Address - Country:US
Mailing Address - Phone:610-710-1158
Mailing Address - Fax:
Practice Address - Street 1:149 HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3964
Practice Address - Country:US
Practice Address - Phone:610-710-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002380133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered