Healthcare Provider Details

I. General information

NPI: 1568534998
Provider Name (Legal Business Name): BETH ANN ARENA B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MARSHALL ST BRIEN CENTER
NORTH ADAMS MA
01247-2451
US

IV. Provider business mailing address

1 MAIN STREET
NORTH ADAMS MA
02147
US

V. Phone/Fax

Practice location:
  • Phone: 413-496-9671
  • Fax: 413-662-3311
Mailing address:
  • Phone: 555-555-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: