Healthcare Provider Details

I. General information

NPI: 1548857154
Provider Name (Legal Business Name): ELIZABETH BATEH ENGEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ROSE BATEH LSCW

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLONNADE DR STE 230
PONTE VEDRA BEACH FL
32081-6237
US

IV. Provider business mailing address

PO BOX 748519
ATLANTA GA
30374-8519
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3800
  • Fax: 904-390-7511
Mailing address:
  • Phone: 904-376-3800
  • Fax: 904-376-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: