Provider Demographics
NPI:1346479797
Name:BETHEA, TAMAR CRYSTAL
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:CRYSTAL
Last Name:BETHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMAR
Other - Middle Name:CRYSTAL
Other - Last Name:MCTEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:665 ARNOW AVE
Mailing Address - Street 2:APARTMENT #4B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7049
Mailing Address - Country:US
Mailing Address - Phone:347-821-2467
Mailing Address - Fax:
Practice Address - Street 1:3600 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1052
Practice Address - Country:US
Practice Address - Phone:718-881-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker