Healthcare Provider Details

I. General information

NPI: 1518291889
Provider Name (Legal Business Name): BETTE LLOYD BACHELOR DEGREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 10/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 WEBSTER AVE 2177 CENTRE AVENUE CONFERENCE ROOM
PITTSBURGH PA
15219-4219
US

IV. Provider business mailing address

2509 WEBSTER AVE 2177 CENTRE AVENUE CONFERENCE ROOM
PITTSBURGH PA
15219-4219
US

V. Phone/Fax

Practice location:
  • Phone: 412-621-2636
  • Fax: 412-552-7052
Mailing address:
  • Phone: 412-621-2636
  • Fax: 412-552-7052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberBACHELORS DEGREE
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBACHELOR DEGREE
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberBACHELOR DEGREE
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberBACHELOR DEGREE
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: