Provider Demographics
NPI:1386041275
Name:BERARD, BETHANY (FCPI)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:BERARD
Suffix:
Gender:F
Credentials:FCPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2703
Mailing Address - Country:US
Mailing Address - Phone:734-649-3061
Mailing Address - Fax:
Practice Address - Street 1:8505 58TH AVE
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2703
Practice Address - Country:US
Practice Address - Phone:734-649-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator