Provider Demographics
NPI:1144652579
Name:BETZ, TYLER (LCSW-C)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BETZ
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1423
Mailing Address - Country:US
Mailing Address - Phone:410-713-1723
Mailing Address - Fax:
Practice Address - Street 1:6 GRACE ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1423
Practice Address - Country:US
Practice Address - Phone:410-713-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD175441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical