Provider Demographics
NPI:1215967310
Name:LANDIS, BETTE A (LCSW)
Entity type:Individual
Prefix:
First Name:BETTE
Middle Name:A
Last Name:LANDIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 SANTA BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4121
Mailing Address - Country:US
Mailing Address - Phone:717-560-4443
Mailing Address - Fax:
Practice Address - Street 1:1689 CROWN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6314
Practice Address - Country:US
Practice Address - Phone:717-560-4443
Practice Address - Fax:717-299-0875
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0149321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1549616Medicaid
PA151899Medicare PIN