| Doctor Name: | MS. BETH B AVERY |
| NPI Number: | 1285658229 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 004996 |
| Business Practice Address: | 5 School St Mystic, CT - 063552717 |
| Business Phone Number: | 8605720667 |
| Business Fax Number: | 8605720667 |
| Mailing Address: | Po Box 253, OLD MYSTIC |
| State: | CT |
| Postal Code: | 063720253 |
| Phone Number: | 8605720667 |
| Fax Number: | 8605720667 |
| NPI Enumeration Date: | 07/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 004996 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |