Provider Demographics
NPI:1710918347
Name:BLUE, BETH-ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH-ANNE
Middle Name:
Last Name:BLUE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 NW 43RD ST
Mailing Address - Street 2:APT. H-60
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-2510
Mailing Address - Country:US
Mailing Address - Phone:352-384-3759
Mailing Address - Fax:
Practice Address - Street 1:1 FLETCHER DR.
Practice Address - Street 2:SHCC
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-7500
Practice Address - Country:US
Practice Address - Phone:352-392-1171
Practice Address - Fax:352-846-1030
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6990103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist