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General NPI Number Information
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NPI Number | 1255804902
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Entity Type | Individual
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Provider Name | BETHANY YATES LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 01/05/2019
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 21095 MATTIE LN APT 308
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City | LEXINGTON PARK
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State | MD
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Zip | 20653-6228
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Country | US
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Telephone | 240-434-8154
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Fax | 240-210-9238
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Provider Business Mailing Address
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Address Line | 21095 MATTIE LN APT 308
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City | LEXINGTON PARK
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State | MD
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Zip | 20653-6228
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Country | US
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Telephone | 240-434-8154
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 23179
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License Number State | MD
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