Provider Demographics
NPI:1912951336
Name:PHYLLIS GOLDBETTER LCSW INC
Entity Type:Organization
Organization Name:PHYLLIS GOLDBETTER LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GOLDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-512-0802
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW37421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6554AMedicare ID - Type UnspecifiedFL MEDICARE PROVIDER NUM.