Provider Demographics
NPI:1346573854
Name:STEPHENS, BETTE VANTRUMP (LCSW)
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:VANTRUMP
Last Name:STEPHENS
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 1:520 SE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-5313
Mailing Address - Country:US
Mailing Address - Phone:352-475-1476
Mailing Address - Fax:
Practice Address - Street 1:520 SE 28TH ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:FL
Practice Address - Zip Code:32666-5313
Practice Address - Country:US
Practice Address - Phone:352-475-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW93831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical