Provider Demographics
NPI:1831202142
Name:KULLMAN-DUVAL, BETHANY ELAINE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:ELAINE
Last Name:KULLMAN-DUVAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 SPINDLEBACK LN
Mailing Address - Street 2:
Mailing Address - City:NEW IPSWICH
Mailing Address - State:NH
Mailing Address - Zip Code:03071-3230
Mailing Address - Country:US
Mailing Address - Phone:603-680-1654
Mailing Address - Fax:978-630-6845
Practice Address - Street 1:55 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-1820
Practice Address - Country:US
Practice Address - Phone:603-680-1654
Practice Address - Fax:978-630-6845
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10310661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical