Provider Demographics
NPI:1083472559
Name:BERNBAUM, BETSY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:MARIE
Last Name:BERNBAUM
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 1:6559 NW 128TH WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1991
Mailing Address - Country:US
Mailing Address - Phone:954-822-5111
Mailing Address - Fax:
Practice Address - Street 1:6559 NW 128TH WAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-1991
Practice Address - Country:US
Practice Address - Phone:954-822-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW227421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty