Provider Demographics
NPI:1497482236
Name:BETTS, TERES (MS)
Entity Type:Individual
Prefix:
First Name:TERES
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 WHALLEY AVENUE
Mailing Address - Street 2:1ST FLOOR SUITE 101
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-439-5555
Mailing Address - Fax:203-738-1117
Practice Address - Street 1:419 WHALLEY AVENUE
Practice Address - Street 2:1ST FLOOR SUITE 101
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-439-5555
Practice Address - Fax:203-738-1117
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004105225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1306401377Medicaid