Provider Demographics
NPI:1710408927
Name:ALTSCHWAGER, BETHANY ANNE (LCAT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANNE
Last Name:ALTSCHWAGER
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3402
Mailing Address - Country:US
Mailing Address - Phone:718-579-7394
Mailing Address - Fax:718-579-7330
Practice Address - Street 1:1276 FULTON AVE RM 208
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-901-8918
Practice Address - Fax:718-901-8918
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001904101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor