Provider Demographics
NPI:1598873895
Name:LEARY, BETH CATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:CATHERINE
Last Name:LEARY
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 1:5217 COMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7362
Mailing Address - Country:US
Mailing Address - Phone:575-439-7354
Mailing Address - Fax:
Practice Address - Street 1:500 S MAIN STE 430
Practice Address - Street 2:CAMPBELL BEHAVIORAL SERVICE
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:505-532-9050
Practice Address - Fax:505-522-3689
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM05029104100000X
NMI063561041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
M05029OtherLMSW
NM81370261Medicaid