Healthcare Provider Details

I. General information

NPI: 1659772671
Provider Name (Legal Business Name): BETHANY J HUTTO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14041 ICOT BLVD
CLEARWATER FL
33760-3702
US

IV. Provider business mailing address

14041 ICOT BLVD
CLEARWATER FL
33760-3702
US

V. Phone/Fax

Practice location:
  • Phone: 727-479-1800
  • Fax: 727-479-1248
Mailing address:
  • Phone: 727-479-1800
  • Fax: 727-479-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 11801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: