MEDICARE: THALIA ANN F 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	103K00000X	Behavior Analyst	1202970	NY

General Provider Information

NPI Number	:	1801745088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THALIA ANN F BETHEL

Provider Business Mailing Address
First Line	:	1608 E 45TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 E 45TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3006
Country	:	US
Telephone Number	:	347-256-5723
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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Directions to “ THALIA ANN F BETHEL ” Practice Location

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