Healthcare Provider Details

I. General information

NPI: 1427572445
Provider Name (Legal Business Name): BETHANY MIFSUD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 SWART HILL RD
AMSTERDAM NY
12010-7084
US

IV. Provider business mailing address

457 SWART HILL RD
AMSTERDAM NY
12010-7084
US

V. Phone/Fax

Practice location:
  • Phone: 518-852-7674
  • Fax:
Mailing address:
  • Phone: 518-852-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092335
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: