Provider Demographics
NPI:1457398927
Name:GOLDBETTER, PHYLLIS CAROL (LCSW)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:CAROL
Last Name:GOLDBETTER
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 1:1420 BRAMPTON CV
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8961
Mailing Address - Country:US
Mailing Address - Phone:561-512-0802
Mailing Address - Fax:561-791-7513
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-512-0802
Practice Address - Fax:561-791-7513
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW37421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6554AMedicare ID - Type UnspecifiedFL MEDICARE PROVIDER NO.