MEDICARE: MRS. BETHANY FITZROY M.S.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1467772442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY FITZROY M.S.

Provider Business Mailing Address
First Line	:	132 ESSEX ST
Second Line	:	APARTMENT 302
City	:	SOUTH HAMILTON
State	:	MA
Zip	:	01982-2315
Country	:	US
Telephone Number	:	978-578-7190
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 ESSEX ST
Second Line	:	APARTMENT 302
City	:	SOUTH HAMILTON
State	:	MA
Zip	:	01982-2315
Country	:	US
Telephone Number	:	978-578-7190
Fax Number	:

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

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	01/06/2011

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