Provider Demographics
NPI:1578054797
Name:HARDY, BETHANY (MA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 ROCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2107
Mailing Address - Country:US
Mailing Address - Phone:603-425-2989
Mailing Address - Fax:603-425-2978
Practice Address - Street 1:63 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3402
Practice Address - Country:US
Practice Address - Phone:603-524-0777
Practice Address - Fax:603-425-2978
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health