Provider Demographics
NPI:1366867558
Name:RADMALL, BETSY (LCSW-S)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:RADMALL
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 DAWN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2800
Mailing Address - Country:US
Mailing Address - Phone:512-635-8691
Mailing Address - Fax:
Practice Address - Street 1:3003 DAWN DR STE 102
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2800
Practice Address - Country:US
Practice Address - Phone:512-635-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical