Beth B Avery, LCSW
Individual provider Active NPI Professional Counselor · Mystic, CT
NPI 1285658229 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1285658229
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 004996 (CT)
- Practice address
- 5 School St
Mystic, CT 06355-2717 - Phone
- (860) 572-0667
- Fax
- (860) 572-0667
- NPI assigned
- Jul 26, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
5 School St
Mystic, CT 06355-2717
Phone (860) 572-0667
PO Box
253 Lantern Hill Rd
Old Mystic, CT 06372-0253
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040915000662 | CT | Practitioner - Clinical Social Worker | 2769459015 | Practice locations: Mystic, CT |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004996 | CT | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 004996 | CT | Yes |
Addresses
Primary practice location
5 School St
Mystic, CT 06355-2717
Mailing address
PO Box 253
Old Mystic, CT 06372-0253
Phone (860) 572-0667
Other providers in Mystic, CT
- Neal Anderson
- Annette L Headley MD LLC
- Tina M Aspromonte-Weiss
- Harvey Wilfred Austin
- Autism Restwise LLC
- Melissa Elizabeth Avery
- Chelsea Andrea Barabtarlo
- Christine M Bauch
- Benchmark Assisted Living LLC
- Victoria A Bergeson
All providers in Mystic, CT · Professional Counselor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.