MEDICARE: MARIE CATHERINE J A KELIN LEE BETHEA 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	C004841	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710018296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE CATHERINE J A KELIN LEE BETHEA LCSW

Provider Business Mailing Address
First Line	:	607 WILTON MEADOW DR
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-4841
Country	:	US
Telephone Number	:	919-773-1219
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 HIGHWOODS BLVD
Second Line	:	SUITE 128
City	:	RALEIGH
State	:	NC
Zip	:	27604-1027
Country	:	US
Telephone Number	:	919-790-8533
Fax Number	:	919-790-8836

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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