Provider Demographics
NPI:1174224646
Name:CZERNICKI, BETHANY A (LMSW)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:A
Last Name:CZERNICKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WALKER AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-8407
Mailing Address - Country:US
Mailing Address - Phone:518-935-7931
Mailing Address - Fax:
Practice Address - Street 1:1600 7TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3410
Practice Address - Country:US
Practice Address - Phone:518-270-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11744601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker