MEDICARE: MICHAELA BETHEL

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	124916	NY

General Provider Information

NPI Number	:	1447064522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA BETHEL

Provider Business Mailing Address
First Line	:	PO BOX 61
Second Line	:
City	:	HELENA
State	:	NY
Zip	:	13649-0061
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 NORTH RD
Second Line	:
City	:	HELENA
State	:	NY
Zip	:	13649-4919
Country	:	US
Telephone Number	:	315-705-7447
Fax Number	:

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

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	02/06/2025

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Directions to “ MICHAELA BETHEL ” Practice Location

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