Provider Demographics
NPI:1730392812
Name:BETTS, TERRI (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1323
Mailing Address - Country:US
Mailing Address - Phone:617-427-7781
Mailing Address - Fax:617-825-7804
Practice Address - Street 1:895 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2902
Practice Address - Country:US
Practice Address - Phone:617-822-0829
Practice Address - Fax:617-825-7804
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7441103TC0700X
MA398518103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0500089Medicaid
MAW05952OtherBLUE CROSS & BLUE SHIELD
MA00274669000OtherAETNA
MA008443OtherHARVARD PILGRIM
MA1028410OtherNEIGHBORHOOD HEALTH PLAN
MA221502102OtherHEALTHCARE VALUE MANAGEME
MA340429OtherMANAGED HEALTH NETWORK
MA471006OtherTUFTS
MA274669000OtherCHILDREN'S MEDICAL SECURI