Provider Demographics
NPI:1710294293
Name:HADVAB, BETHANY M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:M
Last Name:HADVAB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 MAIN ST
Mailing Address - Street 2:APT. 9
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2835
Mailing Address - Country:US
Mailing Address - Phone:860-810-6442
Mailing Address - Fax:
Practice Address - Street 1:409 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1217
Practice Address - Country:US
Practice Address - Phone:508-668-7703
Practice Address - Fax:508-660-9639
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2162321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical