Provider Demographics
NPI:1962594291
Name:HANDFIELD, BETHANY L (LICSW)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:L
Last Name:HANDFIELD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:L
Other - Last Name:KORKUC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:610 WAMPANOAG TRAIL
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:401-431-9870
Mailing Address - Fax:
Practice Address - Street 1:610 WAMPANOAG TRAIL
Practice Address - Street 2:C/O EAST BAY CENTER, INC
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-431-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBK59336Medicaid