1386899672 NPI number — BETHANY LINDSEY FREITAS MA BCBA

Table of content: BETHANY LINDSEY FREITAS MA BCBA (NPI 1386899672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386899672 NPI number — BETHANY LINDSEY FREITAS MA BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREITAS
Provider First Name:
BETHANY
Provider Middle Name:
LINDSEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HESCH
Provider Other First Name:
BETHANY
Provider Other Middle Name:
LINDSEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA BCBA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386899672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05156-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-886-4500
Provider Business Mailing Address Fax Number:
802-886-4560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05156-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-886-4500
Provider Business Practice Location Address Fax Number:
802-886-4560
Provider Enumeration Date:
12/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-20-41776 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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