Provider Demographics
NPI:1386802346
Name:ANDERSON, BETH ELLEN
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ELLEN
Last Name:ANDERSON
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 1:632 KING ST
Mailing Address - Street 2:BRISTOL EXTENDED DAY PROGRAM
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-9202
Mailing Address - Country:US
Mailing Address - Phone:860-584-3891
Mailing Address - Fax:860-584-3893
Practice Address - Street 1:632 KING ST
Practice Address - Street 2:BRISTOL EXTENDED DAY PROGRAM
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-9202
Practice Address - Country:US
Practice Address - Phone:860-584-3891
Practice Address - Fax:860-584-3893
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional