Provider Demographics
NPI:1528140811
Name:GERARD, BETTIE (ACSW LICSW)
Entity type:Individual
Prefix:
First Name:BETTIE
Middle Name:
Last Name:GERARD
Suffix:
Gender:F
Credentials:ACSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CENTERVILLE ROAD
Mailing Address - Street 2:SUMMIT WEST SUITE 101
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-732-4500
Mailing Address - Fax:401-732-7766
Practice Address - Street 1:300 CENTERVILLE ROAD
Practice Address - Street 2:SUMMIT WEST SUITE 101
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-732-4500
Practice Address - Fax:401-732-7766
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00575104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI407854OtherBLUE CHIP
RI34238OtherBLUE CROSS BLUE SHIELD