Provider Demographics
NPI:1710983879
Name:MICHAUD, BETHANY (LCSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:WALCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-0323
Mailing Address - Country:US
Mailing Address - Phone:860-690-7069
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:NEW BRITAIN GENERAL HOSPITAL
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical