Bethany Theodore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

90745 Issued in CA

Practice address

99 Almaden Blvd Ste 600
San Jose, CA 95113-6489

Phone

(707) 527-2064

NPI assigned

Jul 14, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694217600000",
    "number": "1427465277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7614",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197147614",
            "telephone_number": "484-602-9681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 ALMADEN BLVD STE 600",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951136489",
            "telephone_number": "707-527-2064"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7425 Rancho Los Guilicos Rd",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954096519",
            "country_code": "US",
            "telephone_number": "707-565-8682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEODORE",
        "first_name": "BETHANY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-14",
        "last_updated": "2023-09-09",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW59950",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "90745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Lynn Theisen
• Them Huynh M.D., Inc.
• Gordon J. Thenemann, MD
• Theodore Chow MD Inc
• Theodore J. Chu, MD, Allergy and Asthma, Inc.
• Gregory Noah Theodore
• Thera Touch and Healing
• Therapy by Choice Inc
• Rohenna Thiara
• Cheryl June-Ho Thieu, MD

• Clinical Social Worker in San Jose, CA
• Providers in San Jose, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.