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Organization
MICHAEL BETTENCOURT LCSW LLC
Active
Organization
MICHAEL BETTENCOURT LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTENCOURT LCSW (PRESIDENT)
(617) 869-6182
Entity
Organization
Contact information
Practice address
2805 E OAKLAND PARK BLVD # 174, FORT LAUDERDALE, FL 33306-1813
(617) 869-6182
Mailing address
2805 E OAKLAND PARK BLVD # 174, FORT LAUDERDALE, FL 33306-1813
(617) 869-6182
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
111335
MA
1041C0700X
Clinical Social Worker
Primary
13063
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1852612
—
MA
01
—
461417
TUFTS PROVIDER NUMBER
MA
01
—
P08075
BCBS PROVIDER NUMBER
MA
Enumeration date
06/07/2007
Last updated
03/19/2018
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