Provider Demographics
NPI:1558792515
Name:MCBETH, KATIE MICHELLE (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:MICHELLE
Last Name:MCBETH
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:MICHELLE
Other - Last Name:MCBETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R, CASAC
Mailing Address - Street 1:742 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2017
Mailing Address - Country:US
Mailing Address - Phone:315-703-2700
Mailing Address - Fax:315-703-2880
Practice Address - Street 1:742 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2017
Practice Address - Country:US
Practice Address - Phone:315-703-2700
Practice Address - Fax:315-703-2880
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17539101YA0400X
NY077129-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)