Provider Demographics
NPI:1679664916
Name:BETHEM, NANCY D (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:D
Last Name:BETHEM
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RIVER ROCK DR
Mailing Address - Street 2:STE 210
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-988-8885
Mailing Address - Fax:916-987-9749
Practice Address - Street 1:1000 RIVER ROCK DR
Practice Address - Street 2:STE 210
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-988-8885
Practice Address - Fax:916-987-9749
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS169921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ43617ZMedicare ID - Type Unspecified