Provider Demographics
NPI:1437114527
Name:BETHE, CECILIA HONET (PHD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:HONET
Last Name:BETHE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 S EAST END AVE
Mailing Address - Street 2:16F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3164
Mailing Address - Country:US
Mailing Address - Phone:773-752-5692
Mailing Address - Fax:
Practice Address - Street 1:4940 S EAST END AVE
Practice Address - Street 2:16F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-3164
Practice Address - Country:US
Practice Address - Phone:773-752-5692
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1672963OtherBLUE CROSS BLUE SHIELD
169048OtherVALUE OPTIONS
930580Medicare ID - Type Unspecified