Provider Demographics
NPI:1568535946
Name:FIESSINGER, BETTINA VITALE (PSYS)
Entity Type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:VITALE
Last Name:FIESSINGER
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 TEQUESTA DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3092
Mailing Address - Country:US
Mailing Address - Phone:561-745-1750
Mailing Address - Fax:561-844-2522
Practice Address - Street 1:308 TEQUESTA DR
Practice Address - Street 2:SUITE 20
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3092
Practice Address - Country:US
Practice Address - Phone:561-745-1750
Practice Address - Fax:561-844-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH00006029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health