Healthcare Provider Details

I. General information

NPI: 1831284934
Provider Name (Legal Business Name): SANDI BETHEL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BEECHWOOD AVE
PAWTUCKET RI
02860-5402
US

IV. Provider business mailing address

160 BEECHWOOD AVE
PAWTUCKET RI
02860-5402
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-5573
  • Fax: 401-726-5571
Mailing address:
  • Phone: 401-722-5573
  • Fax: 401-726-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01334
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: