Provider Demographics
NPI:1700171667
Name:THERIEN, BETH A (MS ED, BCBA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:THERIEN
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 PAOLI PIKE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2960
Mailing Address - Country:US
Mailing Address - Phone:267-784-7378
Mailing Address - Fax:215-996-0727
Practice Address - Street 1:292 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2960
Practice Address - Country:US
Practice Address - Phone:267-784-7378
Practice Address - Fax:215-996-0727
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1084536103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst