Provider Demographics
NPI:1558552513
Name:THOMAS, BETTY A (LCSW)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 ROSECRANS ST
Mailing Address - Street 2:MS:S528
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3134
Mailing Address - Country:US
Mailing Address - Phone:619-692-8209
Mailing Address - Fax:619-692-5632
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:MS:S528
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3134
Practice Address - Country:US
Practice Address - Phone:619-692-8209
Practice Address - Fax:619-692-5632
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS234751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical