Provider Demographics
NPI:1295335420
Name:CANTOR, BETSY CAROL (LMFT)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:CAROL
Last Name:CANTOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 EUCLID ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4296
Mailing Address - Country:US
Mailing Address - Phone:310-403-5006
Mailing Address - Fax:
Practice Address - Street 1:1011 EUCLID ST UNIT E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4296
Practice Address - Country:US
Practice Address - Phone:310-403-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT24366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT24366OtherCALIFORNIA BBSE