Provider Demographics
NPI:1447272356
Name:CROTTY, BETH ELLEN (PSYD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:CROTTY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2761
Mailing Address - Country:US
Mailing Address - Phone:508-697-9722
Mailing Address - Fax:508-279-0094
Practice Address - Street 1:63 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1455
Practice Address - Country:US
Practice Address - Phone:508-697-9722
Practice Address - Fax:508-279-0094
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6493103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA211604OtherMHN/CHAMPUS
MA424905OtherHARVARD PILGRIM
MAW10518OtherBLUE CROSS
MA680014108OtherRAILROAD MEDICARE
MA424905OtherHARVARD PILGRIM
MAID#W05177Medicare UPIN