Provider Demographics
NPI:1477607026
Name:BETNER, BRUCE ELLIOTT SR (PHD, LMFT, DAPA)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ELLIOTT
Last Name:BETNER
Suffix:SR
Gender:M
Credentials:PHD, LMFT, DAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COOPER ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4640
Mailing Address - Country:US
Mailing Address - Phone:856-579-7303
Mailing Address - Fax:856-579-7298
Practice Address - Street 1:44 COOPER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4640
Practice Address - Country:US
Practice Address - Phone:856-579-7303
Practice Address - Fax:856-579-7298
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000540106H00000X, 101YP2500X
NJ2000366261QR0405X
NJ37FI00162900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37FI00162900OtherMARRIAGE & FAMILY LICENSE
PAMF000540OtherMARRIAGE & FAMILY LICENSE