Provider Demographics
NPI:1245637214
Name:BENDETOWICZ, LISA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BENDETOWICZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BENDETOWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6840 INTERNATIONAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7161
Mailing Address - Country:US
Mailing Address - Phone:239-850-3402
Mailing Address - Fax:
Practice Address - Street 1:6840 INTERNATIONAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7161
Practice Address - Country:US
Practice Address - Phone:239-850-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW61661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical