Provider Demographics
NPI:1366829863
Name:NAGEL, BETHANY (MS LCPC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:NAGEL
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 EASTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3434
Mailing Address - Country:US
Mailing Address - Phone:301-518-6870
Mailing Address - Fax:
Practice Address - Street 1:1200 E JOPPA RD
Practice Address - Street 2:A1
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5810
Practice Address - Country:US
Practice Address - Phone:301-518-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD954126800Medicaid