Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 019234 | NY |
Y | 103T00000X | Psychologist | 019234 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 019234 | NY |
N | 103TS0200X | School Psychologist | 019234 | NY |
NPI | 1063792190 |
---|---|
Provider Name | Dr. Bethany Claes |
First Address | Fairport, NY 14450-3508 |
Second Address | Fairport, NY 14450-3508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2011 |
Last Update Date | 11/04/2012 |