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General NPI Number Information
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NPI Number | 1083152524
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Entity Type | Individual
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Provider Name | PAUL MATTHEW BERTOLINO LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/04/2017
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 145 NW CENTRAL PARK PLZ STE 107
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2482
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Country | US
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Telephone | 772-678-9040
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Fax | 772-673-0790
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Provider Business Mailing Address
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Address Line | 974 SW WORCESTER LN
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2648
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Country | US
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Telephone | 772-678-9040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW17993
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW17993
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License Number State | FL
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