Provider Demographics
NPI:1154406593
Name:GEBHART, BETTY S (LISW)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:S
Last Name:GEBHART
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1183
Mailing Address - Country:US
Mailing Address - Phone:220-564-4870
Mailing Address - Fax:220-564-4871
Practice Address - Street 1:2000 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1183
Practice Address - Country:US
Practice Address - Phone:220-564-4870
Practice Address - Fax:220-564-4871
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-00041371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000019388OtherANTHEM
OH00000019388OtherANTHEM