Provider Demographics
NPI:1568601466
Name:BETTICA, GINA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:BETTICA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8915
Mailing Address - Country:US
Mailing Address - Phone:954-340-0888
Mailing Address - Fax:954-346-0909
Practice Address - Street 1:1881 N UNIVERSITY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8915
Practice Address - Country:US
Practice Address - Phone:954-340-0888
Practice Address - Fax:954-346-0909
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003775103TF0200X
FLPY9161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic