Healthcare Provider Details

I. General information

NPI: 1598757502
Provider Name (Legal Business Name): BETTY ANTHONY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N WABASH AVE
MARION IN
46952-2608
US

IV. Provider business mailing address

505 N WABASH AVE
MARION IN
46952-2608
US

V. Phone/Fax

Practice location:
  • Phone: 765-662-3971
  • Fax: 765-668-6718
Mailing address:
  • Phone: 765-662-3971
  • Fax: 765-668-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000262
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: