Provider Demographics
NPI:1538513924
Name:MYERS, BETINA (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:BETINA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 ACADEMY WAY
Mailing Address - Street 2:LOURIE CENTER SCHOOL
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2000
Mailing Address - Country:US
Mailing Address - Phone:301-984-4444
Mailing Address - Fax:301-984-3866
Practice Address - Street 1:12301 ACADEMY WAY
Practice Address - Street 2:LOURIE CENTER SCHOOL
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2000
Practice Address - Country:US
Practice Address - Phone:301-984-4444
Practice Address - Fax:301-984-3866
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19276104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker