Organization Active NPI

Bethany Detwiler PHD LLC

  • Community/Behavioral Health Agency
  • Allentown, PA
National Provider Identifier
1366927444
Registry record updated Nov 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BETHANY DETWILER PHD LLC
Practice address
121 N Cedar Crest Blvd Ste a
Allentown, PA 18104-4664
Phone
(610) 467-3736
NPI assigned
Sep 25, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bethany Detwiler, PHDNPI 1316491061
Title
Licensed Psychologist
Phone
(610) 467-3736

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

121 N Cedar Crest Blvd Ste a
Allentown, PA 18104-4664

Mailing address

6560 Fernwood Dr
Coopersburg, PA 18036-1011
Phone (856) 343-9582

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181023000357 PA Part B Supplier - Clinic/Group Practice 0345593224 Receives reassigned benefits from 1 practitioner
Practice locations: Allentown, PA

National Provider Directory

National Provider Directory

Locations

121 N Cedar Crest Blvd
Ste A
Allentown, PA 18104
Phone (484) 273-2440

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700784000000",
    "number": "1366927444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6560 FERNWOOD DR",
            "city": "COOPERSBURG",
            "state": "PA",
            "postal_code": "180361011",
            "telephone_number": "856-343-9582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N CEDAR CREST BLVD STE A",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181044664",
            "telephone_number": "610-467-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY DETWILER PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-25",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-24",
        "status": "A",
        "authorized_official_last_name": "DETWILER",
        "authorized_official_first_name": "BETHANY",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "610-467-3736",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.