Provider Demographics
NPI:1508270489
Name:BAGNELL, BETHANY CHERYL (BSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:CHERYL
Last Name:BAGNELL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:CHERYL
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:125 MARKET ST
Mailing Address - Street 2:APT. 242
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-3212
Mailing Address - Country:US
Mailing Address - Phone:703-585-3040
Mailing Address - Fax:
Practice Address - Street 1:125 MARKET ST
Practice Address - Street 2:APT. 242
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-3212
Practice Address - Country:US
Practice Address - Phone:703-585-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker