Healthcare Provider Details

I. General information

NPI: 1023177045
Provider Name (Legal Business Name): BETTINA GABRIELE DEE M.A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/16/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 STARBOARD LN
OSTERVILLE MA
02655-1430
US

IV. Provider business mailing address

175 STARBOARD LN
OSTERVILLE MA
02655-1430
US

V. Phone/Fax

Practice location:
  • Phone: 617-877-8930
  • Fax: 617-576-7234
Mailing address:
  • Phone: 617-877-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT25363
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCMF0215981
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1302
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: