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General NPI Number Information
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NPI Number | 1235995317
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Entity Type | Individual
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Provider Name | BETSIE CIESLAK
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Gender | Male
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 3850 E STATE ROAD 64
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City | BRADENTON
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State | FL
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Zip | 34208-9040
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Country | US
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Telephone | 941-748-2697
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 CASTLE ROCK RD
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City | TAMPA
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State | FL
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Zip | 33612-7672
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW19761
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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