Provider Demographics
NPI:1730077611
Name:SHILDT, BETHNEY
Entity type:Individual
Prefix:
First Name:BETHNEY
Middle Name:
Last Name:SHILDT
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FREDERICK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3709
Mailing Address - Country:US
Mailing Address - Phone:717-969-2894
Mailing Address - Fax:
Practice Address - Street 1:300 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3709
Practice Address - Country:US
Practice Address - Phone:717-969-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)