Basic Information
| Provider Information | |||||||||
| NPI: | 1538513924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | BETINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW, LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12301 ACADEMY WAY | ||||||||
| Address2: | LOURIE CENTER SCHOOL | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208522000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019844444 | ||||||||
| FaxNumber: | 3019843866 | ||||||||
| Practice Location | |||||||||
| Address1: | 12301 ACADEMY WAY | ||||||||
| Address2: | LOURIE CENTER SCHOOL | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208522000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019844444 | ||||||||
| FaxNumber: | 3019843866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2016 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 19276 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.