MEDICARE: BETTY DEAN HYDON LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	106083	MA
2	1041C0700X	Clinical Social Worker	050144	NY

General Provider Information

NPI Number	:	1518927524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY DEAN HYDON LICSW

Provider Business Mailing Address
First Line	:	20 LEWIS AVENUE
Second Line	:
City	:	GT BARRINGTON
State	:	MA
Zip	:	01230
Country	:	US
Telephone Number	:	413-528-1845
Fax Number	:	413-528-3667

Provider Business Practice Location Address
First Line	:	20 LEWIS AVENUE
Second Line	:
City	:	GT BARRINGTON
State	:	MA
Zip	:	01230
Country	:	US
Telephone Number	:	413-528-1845
Fax Number	:	413-528-3667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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