Provider Demographics
NPI:1114931987
Name:NACIM, BETSY E (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:E
Last Name:NACIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3604
Mailing Address - Country:US
Mailing Address - Phone:915-545-1188
Mailing Address - Fax:915-544-9107
Practice Address - Street 1:2332 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3604
Practice Address - Country:US
Practice Address - Phone:915-545-1188
Practice Address - Fax:915-544-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
TX34562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86457QOtherBLUE CROSS BLUE SHIELD
TX102984502Medicaid
TX102984503Medicaid
TX86457QOtherBLUE CROSS BLUE SHIELD