Provider Demographics
NPI:1942626411
Name:SCHOLL-LAVERY, BETHANY
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:SCHOLL-LAVERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEBARTOLO PL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 DEBARTOLO PL
Practice Address - Street 2:SUITE 220
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-7011
Practice Address - Country:US
Practice Address - Phone:330-702-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3094413103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH3094413Medicare PIN