Provider Demographics
NPI:1053692210
Name:PETTYJOHN, BETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:PETTYJOHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MCCLIMENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29L ATLANTIC AVE # 173
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19970-9115
Mailing Address - Country:US
Mailing Address - Phone:302-500-2626
Mailing Address - Fax:888-216-2869
Practice Address - Street 1:32630 CEDAR DR UNIT A
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6946
Practice Address - Country:US
Practice Address - Phone:302-500-2626
Practice Address - Fax:888-216-2869
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500791641041C0700X
VA09040095241041C0700X
DEQ1-00017631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical