Provider Demographics
NPI:1679053714
Name:CAMARATA, BETHANY ANN (LCSW CCTP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:CAMARATA
Suffix:
Gender:F
Credentials:LCSW CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13403 N GOVERNMENT WAY STE 319
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8914
Mailing Address - Country:US
Mailing Address - Phone:208-819-7566
Mailing Address - Fax:
Practice Address - Street 1:11648 N AVONDALE LOOP
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9157
Practice Address - Country:US
Practice Address - Phone:208-819-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-410391041C0700X
IDLMSW-37876104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker