Provider Demographics
NPI:1992487755
Name:ONOFRIO, BETHANY ANN (LMSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:ONOFRIO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WEBSTER CT
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5124
Mailing Address - Country:US
Mailing Address - Phone:860-877-1899
Mailing Address - Fax:
Practice Address - Street 1:130 WEBSTER CT
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-5124
Practice Address - Country:US
Practice Address - Phone:860-877-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health