MEDICARE: LISA BENDETOWICZ, LCSW, LLC

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

General Provider Information

NPI Number	:	1487200754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA BENDETOWICZ, LCSW, LLC

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	:	239-985-1050
Fax Number	:	239-985-1060

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LISA BENDETOWICZ
Credential	:	LCSW
Telephone Number	:	239-850-3402

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	06/15/2020

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