Doctor Name: | BETHEL ELAINE SUCRO |
NPI Number: | 1942366497 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | PC002830 |
Business Practice Address: | Rr1 Route 611 Tannersville, PA - 18372 |
Business Phone Number: | 5702368944 |
Business Fax Number: | 5706298408 |
Mailing Address: | 238 Recreation Dr, EFFORT |
State: | PA |
Postal Code: | 183309038 |
Phone Number: | 5702368944 |
Fax Number: | 5706298408 |
NPI Enumeration Date: | 12/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC002830 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |