MEDICARE: MRS. LISA BENDETOWICZ 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	SW6166	FL

General Provider Information

NPI Number	:	1245637214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA BENDETOWICZ LCSW

Provider Business Mailing Address
First Line	:	6840 INTERNATIONAL CENTER BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7161
Country	:	US
Telephone Number	:	239-850-3402
Fax Number	:

Provider Business Practice Location Address
First Line	:	6840 INTERNATIONAL CENTER BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7161
Country	:	US
Telephone Number	:	239-850-3402
Fax Number	:

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

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	06/15/2020

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