MEDICARE: BETHANY MAE HANLINE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	125946	MA

General Provider Information

NPI Number	:	1417462425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY MAE HANLINE LICSW

Provider Business Mailing Address
First Line	:	876 GRATTAN ST
Second Line	:
City	:	CHICOPEE
State	:	MA
Zip	:	01020-1247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 UNIVERSITY BLVD E
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-2866
Country	:	US
Telephone Number	:	301-650-6650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	01/16/2025

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