=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518291889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETTE LLOYD BACHELOR DEGREE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2009
-----------------------------------------------------
Last Update Date | 10/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2509 WEBSTER AVE 2177 CENTRE AVENUE CONFERENCE ROOM
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-621-2636
-----------------------------------------------------
Fax | 412-552-7052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2509 WEBSTER AVE 2177 CENTRE AVENUE CONFERENCE ROOM
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-621-2636
-----------------------------------------------------
Fax | 412-552-7052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | BACHELORS DEGREE
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | BACHELOR DEGREE
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TM1800X
-----------------------------------------------------
Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
-----------------------------------------------------
License Number | BACHELOR DEGREE
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | BACHELOR DEGREE
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------