Provider Demographics
NPI:1275018988
Name:GONCALVES, BETH (ASW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:CHALFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:207 GEORGE ST APT 431
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3599
Mailing Address - Country:US
Mailing Address - Phone:914-420-2821
Mailing Address - Fax:
Practice Address - Street 1:381A NEVADA ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3756
Practice Address - Country:US
Practice Address - Phone:916-786-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CT123461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator