Bethany Diedrich Taylor, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW03284 Issued in RI

Practice address

99 Water St Unit 204
Warren, RI 02885-3084

Phone

(401) 556-9044

NPI assigned

Dec 20, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bethany Kristen Diedrich Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1831605310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 WATER ST UNIT 204",
            "city": "WARREN",
            "state": "RI",
            "postal_code": "028853084",
            "telephone_number": "401-556-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 WATER ST UNIT 204",
            "city": "WARREN",
            "state": "RI",
            "postal_code": "028853084",
            "telephone_number": "401-556-9044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 E Ferry St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482023802",
            "country_code": "US",
            "telephone_number": "734-785-7750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "BETHANY",
        "middle_name": "DIEDRICH",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-20",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW03284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSOCIATION OF SOCIAL WORK BOARD",
            "identifier": "ISW03284",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETHANY",
            "last_name": "DIEDRICH",
            "middle_name": "KRISTEN",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Warren, RI
• Providers in Warren, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.