MEDICARE: BETHANY GINN RESTREPO LCSW

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	079302	NY
2	1041C0700X	Clinical Social Worker	079302-1	NY

General Provider Information

NPI Number	:	1538301445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY GINN RESTREPO LCSW

Provider Business Mailing Address
First Line	:	343 4TH AVE APT 11A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2724
Country	:	US
Telephone Number	:	904-571-0993
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 4TH AVE APT 11A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2724
Country	:	US
Telephone Number	:	646-640-6864
Fax Number	:

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

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	01/23/2021

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