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General NPI Number Information
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NPI Number | 1518473586
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Entity Type | Organization
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Legal Business Name | BORTOT COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 850 NW FEDERAL HWY STE 108
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City | STUART
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State | FL
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Zip | 34994-1019
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Country | US
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Telephone | 561-331-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 850 NW FEDERAL HWY STE 108
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City | STUART
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State | FL
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Zip | 34994-1019
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Country | US
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Telephone | 561-331-0909
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOTHERAPIST / OWNER
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Name | KIM BORTOT
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Credential | MSW, LCSW
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Telephone | 561-703-3926
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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 | SW13023
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License Number State | FL
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