Healthcare Provider Details

I. General information

NPI: 1386845865
Provider Name (Legal Business Name): MS. CAROL BEATTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL BEATTY LCSW

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8054 VALENCIA ST
APTOS CA
95003-3984
US

IV. Provider business mailing address

1515 HIDDEN TERRACE CT
SANTA CRUZ CA
95062-2948
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-8553
  • Fax:
Mailing address:
  • Phone: 831-476-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: