Healthcare Provider Details

I. General information

NPI: 1417462425
Provider Name (Legal Business Name): BETHANY MAE HANLINE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 UNIVERSITY BLVD E
SILVER SPRING MD
20901-2866
US

IV. Provider business mailing address

876 GRATTAN ST
CHICOPEE MA
01020-1247
US

V. Phone/Fax

Practice location:
  • Phone: 301-650-6650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125946
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: