Provider Demographics
NPI:1205992005
Name:DE BETHUNE, MARIE THERESE (ATR-BC, LCAT)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:THERESE
Last Name:DE BETHUNE
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:MRS
Other - First Name:MIA
Other - Middle Name:T
Other - Last Name:WETHERELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:196 WARBURTON AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3706
Mailing Address - Country:US
Mailing Address - Phone:914-478-4707
Mailing Address - Fax:
Practice Address - Street 1:145 PALISADE ST
Practice Address - Street 2:RM 402
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1617
Practice Address - Country:US
Practice Address - Phone:914-584-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000660-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist