Provider Demographics
NPI:1063792190
Name:CLAES, BETHANY (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:CLAES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 CROSSKEYS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3508
Mailing Address - Country:US
Mailing Address - Phone:585-223-5920
Mailing Address - Fax:585-223-5727
Practice Address - Street 1:620 CROSSKEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3508
Practice Address - Country:US
Practice Address - Phone:585-223-5920
Practice Address - Fax:585-223-5727
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019234103T00000X, 103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool