Healthcare Provider Details

I. General information

NPI: 1154406593
Provider Name (Legal Business Name): BETTY S. GEBHART LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 TAMARACK RD
NEWARK OH
43055-1183
US

IV. Provider business mailing address

2000 TAMARACK RD
NEWARK OH
43055-1183
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4870
  • Fax: 220-564-4871
Mailing address:
  • Phone: 220-564-4870
  • Fax: 220-564-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1-0004137
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: