Provider Demographics
NPI:1568483428
Name:TOOLIN, BETHANY (LCMHC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:TOOLIN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6217
Mailing Address - Country:US
Mailing Address - Phone:603-714-4039
Mailing Address - Fax:603-626-7368
Practice Address - Street 1:201 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6763
Practice Address - Country:US
Practice Address - Phone:603-668-4646
Practice Address - Fax:603-626-7368
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH1119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1302272Medicaid