Provider Demographics
NPI:1508255548
Name:SMITH, BETTY (CSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E BROADWAY AVE
Mailing Address - Street 2:FEDERAL BLDG, RM 353
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4082
Mailing Address - Country:US
Mailing Address - Phone:701-255-2048
Mailing Address - Fax:701-255-2066
Practice Address - Street 1:304 E BROADWAY AVE
Practice Address - Street 2:FEDERAL BLDG, RM 353
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4082
Practice Address - Country:US
Practice Address - Phone:701-255-2048
Practice Address - Fax:701-255-2066
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6745104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker