Provider Demographics
NPI:1922040625
Name:MCINNIS-IPPOLITO, BETTE L (PHD)
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:L
Last Name:MCINNIS-IPPOLITO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0940
Mailing Address - Country:US
Mailing Address - Phone:603-490-8225
Mailing Address - Fax:978-858-3795
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1950
Practice Address - Country:US
Practice Address - Phone:978-851-7321
Practice Address - Fax:978-858-3795
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical