Provider Demographics
NPI:1336686443
Name:PHYLLIS J. BETTS, LCSW-C, LLC
Entity Type:Organization
Organization Name:PHYLLIS J. BETTS, LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-980-5573
Mailing Address - Street 1:13704 BEAUWICK CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3005
Mailing Address - Country:US
Mailing Address - Phone:301-980-5573
Mailing Address - Fax:
Practice Address - Street 1:13704 BEAUWICK CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3005
Practice Address - Country:US
Practice Address - Phone:301-980-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13435104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD063855200Medicaid