Provider Demographics
NPI:1063291276
Name:CONTRERAS, BETHANIA
Entity type:Individual
Prefix:
First Name:BETHANIA
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 GRANT AVE APT 5D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3165
Mailing Address - Country:US
Mailing Address - Phone:845-332-7871
Mailing Address - Fax:
Practice Address - Street 1:10450 102ND ST APT 2E
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2204
Practice Address - Country:US
Practice Address - Phone:929-354-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician