Provider Demographics
NPI:1528661121
Name:GARRISON, BETTY G (MA, MS, LMHC)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:G
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MA, MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4320
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-0776
Mailing Address - Country:US
Mailing Address - Phone:516-852-4555
Mailing Address - Fax:
Practice Address - Street 1:1051 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2219
Practice Address - Country:US
Practice Address - Phone:516-785-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty