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Provider Information for 1285658229


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Ms. BETH B AVERY LCSW


Sex: Female

NPI: 1285658229
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1285658229
Enumeration Date2006-07-26
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address PO BOX 253
OLD MYSTIC, CT 06372-0253
United States

Phone: 860-572-0667 | Fax:860-572-0667
 
Primary Practice Address 5 SCHOOL ST
MYSTIC, CT 06355-2717
United States

Phone: 860-572-0667 | Fax:860-572-0667
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalCT004996