Provider Demographics
NPI:1750449948
Name:RICE, BETTY C (LCSW)
Entity type:Individual
Prefix:PROF
First Name:BETTY
Middle Name:C
Last Name:RICE
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 1:1901 JOHN F KENNEDY BLVD APT 2519
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1521
Mailing Address - Country:US
Mailing Address - Phone:215-567-5953
Mailing Address - Fax:215-567-7230
Practice Address - Street 1:1616 WALNUT ST
Practice Address - Street 2:SUITE 811
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5313
Practice Address - Country:US
Practice Address - Phone:215-567-5953
Practice Address - Fax:215-567-7230
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0124381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053522Medicare ID - Type Unspecified