Provider Demographics
NPI:1538301445
Name:RESTREPO, BETHANY GINN (LCSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:GINN
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:GINN
Other - Last Name:WALDROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:343 4TH AVE APT 11A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2724
Mailing Address - Country:US
Mailing Address - Phone:904-571-0993
Mailing Address - Fax:
Practice Address - Street 1:343 4TH AVE APT 11A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2724
Practice Address - Country:US
Practice Address - Phone:646-640-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0793021041C0700X
NY079302-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical