Provider Demographics
NPI:1245776996
Name:BETZOLD, LORINDA (QMHS, CDCA)
Entity Type:Individual
Prefix:
First Name:LORINDA
Middle Name:
Last Name:BETZOLD
Suffix:
Gender:F
Credentials:QMHS, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2144
Mailing Address - Country:US
Mailing Address - Phone:419-352-4624
Mailing Address - Fax:
Practice Address - Street 1:718 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2144
Practice Address - Country:US
Practice Address - Phone:419-352-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker