Provider Demographics
NPI:1215110978
Name:FUCCI, BETHANY R
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:R
Last Name:FUCCI
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 1:6515 WATTS RD
Mailing Address - Street 2:STE 206
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2726
Mailing Address - Country:US
Mailing Address - Phone:608-238-5826
Mailing Address - Fax:608-238-1221
Practice Address - Street 1:6515 WATTS RD
Practice Address - Street 2:STE 206
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2726
Practice Address - Country:US
Practice Address - Phone:608-238-5826
Practice Address - Fax:608-238-1221
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4242-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional