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General NPI Number Information
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NPI Number | 1053692210
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Entity Type | Individual
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Provider Name | BETH PETTYJOHN LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 32630 CEDAR DR UNIT A
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City | MILLVILLE
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State | DE
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Zip | 19967-6946
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Country | US
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Telephone | 302-500-2626
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Fax | 888-216-2869
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Provider Business Mailing Address
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Address Line | 29L ATLANTIC AVE # 173
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City | MILLVILLE
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State | DE
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Zip | 19970-9115
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Country | US
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Telephone | 302-500-2626
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Fax | 888-216-2869
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50079164
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009524
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | Q1-0001763
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License Number State | DE
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