Provider Demographics
NPI:1467813733
Name:MILFORD, BETHANIE (LMSW)
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:
Last Name:MILFORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 WELLINGTON CT
Mailing Address - Street 2:#4F
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7598
Mailing Address - Country:US
Mailing Address - Phone:850-567-1590
Mailing Address - Fax:
Practice Address - Street 1:171 WELLINGTON CT
Practice Address - Street 2:#4F
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7598
Practice Address - Country:US
Practice Address - Phone:850-567-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097197-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical