Provider Demographics
NPI:1386845865
Name:BEATTY, CAROL
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:BEATTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1515 HIDDEN TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2948
Mailing Address - Country:US
Mailing Address - Phone:831-476-7834
Mailing Address - Fax:
Practice Address - Street 1:8054 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3984
Practice Address - Country:US
Practice Address - Phone:831-427-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS146321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ33610ZMedicare ID - Type UnspecifiedID NUMBER