Provider Demographics
NPI:1578963542
Name:HETRICK, BETSY L (PC)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:L
Last Name:HETRICK
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 FRANKLIN HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201
Mailing Address - Country:US
Mailing Address - Phone:724-543-1888
Mailing Address - Fax:724-543-1898
Practice Address - Street 1:334 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:PA
Practice Address - Zip Code:16232
Practice Address - Country:US
Practice Address - Phone:814-797-0291
Practice Address - Fax:814-797-0281
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007757101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional