Provider Demographics
NPI:1881409522
Name:TY, BETHANY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:TY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BYSTREK DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-8706
Mailing Address - Country:US
Mailing Address - Phone:203-500-8445
Mailing Address - Fax:
Practice Address - Street 1:77 BYSTREK DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-8706
Practice Address - Country:US
Practice Address - Phone:203-500-8445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical