Basic Information
| Provider Information | |||||||||
| NPI: | 1619472370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDOWELL | ||||||||
| FirstName: | BETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 633 GIDNEY AVE STE 6 | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125502805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455692900 | ||||||||
| FaxNumber: | 8666195710 | ||||||||
| Practice Location | |||||||||
| Address1: | 633 GIDNEY AVE STE 6 | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125502805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455692900 | ||||||||
| FaxNumber: | 8666195710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2018 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 005868-1 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 115868-1 | 01 | NY | LICENSE | OTHER |