Provider Demographics
NPI:1134210958
Name:HYATT, MARY BETH (LISW-CP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:HYATT
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2427
Mailing Address - Country:US
Mailing Address - Phone:864-649-5123
Mailing Address - Fax:864-515-4403
Practice Address - Street 1:107 W FREDERICK ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2427
Practice Address - Country:US
Practice Address - Phone:864-649-5123
Practice Address - Fax:864-515-4403
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8383104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCW79245SC1Medicaid