Provider Demographics
NPI:1396511804
Name:FITZSIMMONS, BETHANY ADAIR (LCSW-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ADAIR
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 4170 BOX 169
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AE
Mailing Address - Zip Code:09862-0169
Mailing Address - Country:US
Mailing Address - Phone:443-768-7277
Mailing Address - Fax:
Practice Address - Street 1:2A LAI RESIDENCE 8F NO. 1, LANE 91 SHI-DONG ROAD
Practice Address - Street 2:
Practice Address - City:TAIPEI
Practice Address - State:TAIPEI
Practice Address - Zip Code:111034
Practice Address - Country:TW
Practice Address - Phone:410-935-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD248351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical