Provider Demographics
NPI:1316179542
Name:PEARL, BETSY JO (LCSW)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:JO
Last Name:PEARL
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 1:5837 NORTHPOINTE LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2008
Mailing Address - Country:US
Mailing Address - Phone:561-632-5656
Mailing Address - Fax:
Practice Address - Street 1:5837 NORTHPOINTE LN
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2008
Practice Address - Country:US
Practice Address - Phone:561-632-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201966531OtherTAX ID