Provider Demographics
NPI:1831240779
Name:BETZENDAHL, LINDSAY (MA, LMFT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:BETZENDAHL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 BUCKLAND HILLS DR
Mailing Address - Street 2:APT. 25122
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-9100
Mailing Address - Country:US
Mailing Address - Phone:860-808-6959
Mailing Address - Fax:
Practice Address - Street 1:1750 ELLINGTON RD
Practice Address - Street 2:BUILDING 3
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2746
Practice Address - Country:US
Practice Address - Phone:860-808-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001283106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist