Provider Demographics
NPI:1760877369
Name:NELSON, BETHANY WALSH (MED)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:WALSH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 EUSTIS AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1432
Mailing Address - Country:US
Mailing Address - Phone:617-999-5124
Mailing Address - Fax:
Practice Address - Street 1:71 EUSTIS AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1409
Practice Address - Country:US
Practice Address - Phone:617-999-5124
Practice Address - Fax:978-777-8547
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3734103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst