Healthcare Provider Details

I. General information

NPI: 1710104252
Provider Name (Legal Business Name): BETHANNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WHARTON ST
PHILADELPHIA PA
19146-3942
US

IV. Provider business mailing address

1844 STREET RD
SOUTHAMPTON PA
18966-4582
US

V. Phone/Fax

Practice location:
  • Phone: 215-355-6500
  • Fax: 215-564-4740
Mailing address:
  • Phone: 215-355-6500
  • Fax: 215-355-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN HAMILTON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 215-355-6500