Provider Demographics
NPI:1598484487
Name:THEOBOLD, BETHANY (LCSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:THEOBOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:47 W POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3217
Mailing Address - Country:US
Mailing Address - Phone:717-258-0214
Mailing Address - Fax:717-258-3158
Practice Address - Street 1:47 W POMFRET ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3217
Practice Address - Country:US
Practice Address - Phone:717-258-0214
Practice Address - Fax:717-258-3158
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0229531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical