Provider Demographics
NPI:1760516231
Name:HERRINGTON-BATEMAN, MARY BETH (PHD, LISW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:HERRINGTON-BATEMAN
Suffix:
Gender:F
Credentials:PHD, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1902
Mailing Address - Country:US
Mailing Address - Phone:614-314-4620
Mailing Address - Fax:614-481-2174
Practice Address - Street 1:1943 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1902
Practice Address - Country:US
Practice Address - Phone:614-314-4620
Practice Address - Fax:614-481-2174
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00030841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000116445OtherBLUE CROSS BLUE SHIELD
OHSW18611Medicare PIN