Provider Demographics
NPI:1255766895
Name:BOVE, BETTINA J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:J
Last Name:BOVE
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 1:56 JEROME DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-1800
Mailing Address - Country:US
Mailing Address - Phone:516-673-6171
Mailing Address - Fax:516-586-3457
Practice Address - Street 1:20 CANDLEWOOD PATH
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5304
Practice Address - Country:US
Practice Address - Phone:516-673-6171
Practice Address - Fax:516-586-3457
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073413-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical