Provider Demographics
NPI:1962552430
Name:KAMMERUD, BETSY R (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETSY
Middle Name:R
Last Name:KAMMERUD
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 1:406 E 50TH ST
Mailing Address - Street 2:APT B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2349
Mailing Address - Country:US
Mailing Address - Phone:912-655-0748
Mailing Address - Fax:
Practice Address - Street 1:450 MALL BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4824
Practice Address - Country:US
Practice Address - Phone:912-629-1409
Practice Address - Fax:912-303-0242
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0040721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical