Provider Demographics
NPI:1720564529
Name:HAKES, BETHANIE (MA)
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:
Last Name:HAKES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-9158
Mailing Address - Country:US
Mailing Address - Phone:302-359-3933
Mailing Address - Fax:
Practice Address - Street 1:10 CORPORATE CIR STE 201
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2418
Practice Address - Country:US
Practice Address - Phone:302-359-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101YM0800X
DE1445595106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician