Provider Demographics
NPI:1134497266
Name:GOODMAN-BITMAN, BETSY DALE (CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:DALE
Last Name:GOODMAN-BITMAN
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 VARSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1040
Mailing Address - Country:US
Mailing Address - Phone:631-751-4864
Mailing Address - Fax:
Practice Address - Street 1:34900 MAIN RD
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1338
Practice Address - Country:US
Practice Address - Phone:631-734-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0076441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist