Provider Demographics
NPI:1699087460
Name:NOLAN, BETHANNE (MED)
Entity type:Individual
Prefix:
First Name:BETHANNE
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 NANTASKET AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-1551
Mailing Address - Country:US
Mailing Address - Phone:781-773-1043
Mailing Address - Fax:
Practice Address - Street 1:39A INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4868
Practice Address - Country:US
Practice Address - Phone:508-830-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health