MEDICARE: TRICIA BETTERS-BLACK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW12808	FL

General Provider Information

NPI Number	:	1194103606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA BETTERS-BLACK LCSW

Provider Business Mailing Address
First Line	:	215 SW 11TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2554
Country	:	US
Telephone Number	:	239-313-1920
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 NE 11TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-1547
Country	:	US
Telephone Number	:	239-313-1920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2015
Last Update Date	:	05/16/2015

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