Provider Demographics
NPI:1275599870
Name:BETTIGOLE, BRYNA BAGAN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BRYNA
Middle Name:BAGAN
Last Name:BETTIGOLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WILCOX AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5736
Mailing Address - Country:US
Mailing Address - Phone:401-723-0353
Mailing Address - Fax:
Practice Address - Street 1:29 WILCOX AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5736
Practice Address - Country:US
Practice Address - Phone:401-723-0353
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical