Provider Demographics
NPI:1609011915
Name:WEBSTER, BETH MATTOON
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MATTOON
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 COUNTY COMPLEX DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9505
Mailing Address - Country:US
Mailing Address - Phone:585-396-4358
Mailing Address - Fax:585-396-4551
Practice Address - Street 1:3019 COUNTY COMPLEX DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9505
Practice Address - Country:US
Practice Address - Phone:585-396-4358
Practice Address - Fax:585-396-4551
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator