Provider Demographics
NPI:1225087232
Name:STRUZICK, BETTY H (MSW)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:H
Last Name:STRUZICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 N TENNESSEE BLVD APT 605
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4538
Mailing Address - Country:US
Mailing Address - Phone:205-902-5082
Mailing Address - Fax:
Practice Address - Street 1:2900 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-867-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPIP04780361C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051501299OtherBCBS OF AL
AL051501299OtherBCBS OF AL
AL051501299Medicare ID - Type Unspecified