Healthcare Provider Details

I. General information

NPI: 1063667194
Provider Name (Legal Business Name): BETH TOOKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 WILTON RD
GREENFIELD CENTER NY
12833-1842
US

IV. Provider business mailing address

PO BOX 365
GREENFIELD CENTER NY
12833-0365
US

V. Phone/Fax

Practice location:
  • Phone: 518-598-3255
  • Fax:
Mailing address:
  • Phone: 518-598-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number053918-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: