Provider Demographics
NPI:1457387219
Name:KLINK, BETH ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:KLINK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:TABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:722 ATKINS ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1523
Mailing Address - Country:US
Mailing Address - Phone:860-704-8287
Mailing Address - Fax:
Practice Address - Street 1:YALE-NEW HAVEN PSYCHIATRIC HOSPITAL
Practice Address - Street 2:20 YORK STREET
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-688-9706
Practice Address - Fax:203-688-9709
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0021121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002436Medicare ID - Type Unspecified