MEDICARE: HIGOR DE FREITAS BENTO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LICSW1141572	MA
2	1041C0700X	Clinical Social Worker	L16606	OR
3	1041C0700X	Clinical Social Worker	CA134904	CA
4	1041C0700X	Clinical Social Worker	SW23903	FL

General Provider Information

NPI Number	:	1205691276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIGOR DE FREITAS BENTO LCSW

Provider Business Mailing Address
First Line	:	3127 LIBERTY ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3712
Country	:	US
Telephone Number	:	305-399-0499
Fax Number	:

Provider Business Practice Location Address
First Line	:	3127 LIBERTY ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3712
Country	:	US
Telephone Number	:	305-399-0499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	11/07/2025

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