Provider Demographics
NPI:1366894321
Name:BERSON, BETHANIE SHANA (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:BETHANIE
Middle Name:SHANA
Last Name:BERSON
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 OCEAN PARKWAY
Mailing Address - Street 2:ROOM 416
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-616-5373
Mailing Address - Fax:718-616-5444
Practice Address - Street 1:2601 OCEAN PARKWAY
Practice Address - Street 2:ROOM 416
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-616-5373
Practice Address - Fax:718-616-5444
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY694643163W00000X
NY40 402093363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse