Provider Demographics
NPI:1689140667
Name:PINSONNEAULT, BETHANY (LMSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:PINSONNEAULT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 VISTA ABAJO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2247
Mailing Address - Country:US
Mailing Address - Phone:505-553-5549
Mailing Address - Fax:
Practice Address - Street 1:704 VISTA ABAJO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2247
Practice Address - Country:US
Practice Address - Phone:505-553-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-10381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM16931386Medicaid