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General NPI Number Information
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NPI Number | 1053763169
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Entity Type | Organization
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Legal Business Name | LISA BENTIVENGA LCSW P LLC
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 322 W BEARSS AVE
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City | TAMPA
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State | FL
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Zip | 33613-1228
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Country | US
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Telephone | 813-505-1949
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Fax | 813-651-5465
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Provider Business Mailing Address
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Address Line | 4010 HARBOR LAKE DR
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City | LUTZ
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State | FL
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Zip | 33558-9731
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Country | US
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Telephone | 813-505-1949
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Fax | 813-651-5465
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Authorized Official
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Title or Position | LSCW
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Name | LISA BENTIVENGA
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Credential | LCSW
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Telephone | 813-505-1949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW11270
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License Number State | FL
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