Provider Demographics
NPI:1629495213
Name:FIFE, BETH ANNE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:FIFE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 DAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:EAST EARL
Mailing Address - State:PA
Mailing Address - Zip Code:17519-9275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:283 SOUTH BUTLER RD
Practice Address - Street 2:
Practice Address - City:MOUNT GRETNA
Practice Address - State:PA
Practice Address - Zip Code:17064-0550
Practice Address - Country:US
Practice Address - Phone:717-273-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health