Provider Demographics
NPI:1669975934
Name:BETO, STACI (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:STACI
Middle Name:
Last Name:BETO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:SCHRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15594 MN-27
Mailing Address - Street 2:STE 4
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345
Mailing Address - Country:US
Mailing Address - Phone:203-360-9455
Mailing Address - Fax:
Practice Address - Street 1:15594 MN-27
Practice Address - Street 2:STE 4
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345
Practice Address - Country:US
Practice Address - Phone:203-360-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN230131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical