Provider Demographics
NPI:1063926459
Name:BETZ, CHERYL ANN (MA, LMSW)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:BETZ
Suffix:
Gender:F
Credentials:MA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1703
Mailing Address - Country:US
Mailing Address - Phone:810-844-9204
Mailing Address - Fax:
Practice Address - Street 1:14149 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5422
Practice Address - Country:US
Practice Address - Phone:734-266-1421
Practice Address - Fax:734-266-1422
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010358781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical