Provider Demographics
NPI:1417047150
Name:BETTS, BETTE B (MSW)
Entity Type:Individual
Prefix:MS
First Name:BETTE
Middle Name:B
Last Name:BETTS
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 1:1920 TIJERAS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3352
Mailing Address - Country:US
Mailing Address - Phone:505-310-1074
Mailing Address - Fax:505-992-6145
Practice Address - Street 1:1012 MARQUEZ PL
Practice Address - Street 2:SUITE 211 A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1834
Practice Address - Country:US
Practice Address - Phone:505-310-1074
Practice Address - Fax:505-992-6145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-16981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA1073Medicaid