Provider Demographics
NPI:1811664733
Name:SARFF, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SARFF
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 1:407 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA MOILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61330-9479
Mailing Address - Country:US
Mailing Address - Phone:815-878-6206
Mailing Address - Fax:
Practice Address - Street 1:407 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LA MOILLE
Practice Address - State:IL
Practice Address - Zip Code:61330-9479
Practice Address - Country:US
Practice Address - Phone:815-878-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst