Provider Demographics
NPI:1245377738
Name:BETHEL, HILLARY M
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:M
Last Name:BETHEL
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 1:17615 SW 97TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5636
Mailing Address - Country:US
Mailing Address - Phone:786-624-2679
Mailing Address - Fax:786-268-1748
Practice Address - Street 1:17615 SW 97TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5636
Practice Address - Country:US
Practice Address - Phone:786-624-2679
Practice Address - Fax:786-268-1748
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003069500Medicaid
FL767147400Medicaid