MEDICARE: MS. CANDICE N BETTS LLMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6801094923	MI

General Provider Information

NPI Number	:	1912243080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANDICE N BETTS LLMSW

Provider Business Mailing Address
First Line	:	19453 OAKFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2215
Country	:	US
Telephone Number	:	313-702-8272
Fax Number	:

Provider Business Practice Location Address
First Line	:	19453 OAKFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2215
Country	:	US
Telephone Number	:	313-702-8272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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