Provider Demographics
NPI:1376258509
Name:SMALLEY, BETH (LPAT, LCAT)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:LPAT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9472
Mailing Address - Country:US
Mailing Address - Phone:732-616-4845
Mailing Address - Fax:
Practice Address - Street 1:185 BROADWAY
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2054
Practice Address - Country:US
Practice Address - Phone:732-616-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000101221700000X
NJ16LP00011900221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist