Provider Demographics
NPI:1295284289
Name:FERRATO, BETHANY JANE (LMSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JANE
Last Name:FERRATO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:JANE
Other - Last Name:FERRATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:22 SIMKIN DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3211
Mailing Address - Country:US
Mailing Address - Phone:845-641-3840
Mailing Address - Fax:
Practice Address - Street 1:116 W 32ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3212
Practice Address - Country:US
Practice Address - Phone:212-564-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17Medicaid