Provider Demographics
NPI:1952086530
Name:LIVSEY, MARY BETHANY (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETHANY
Last Name:LIVSEY
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GILREATH RD NW APT 49B
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-6067
Mailing Address - Country:US
Mailing Address - Phone:770-910-5108
Mailing Address - Fax:
Practice Address - Street 1:25 GILREATH RD NW APT 49B
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-6067
Practice Address - Country:US
Practice Address - Phone:770-910-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009236104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker