Provider Demographics
NPI:1366846388
Name:DWYER, BETH ANNE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:BETH
Middle Name:ANNE
Last Name:DWYER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 DENISON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2733
Mailing Address - Country:US
Mailing Address - Phone:732-359-2564
Mailing Address - Fax:732-359-2564
Practice Address - Street 1:90 WASHINGTON VALLEY RD
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2118
Practice Address - Country:US
Practice Address - Phone:732-359-2564
Practice Address - Fax:732-359-2564
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00769400101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4144007Medicaid
NJ31-4011OtherMEDICARE