Provider Demographics
NPI:1427531714
Name:DOSSANTOS, BETTY (LADC)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
Last Name:DOSSANTOS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:SA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5323
Mailing Address - Country:US
Mailing Address - Phone:203-362-3900
Mailing Address - Fax:203-362-3919
Practice Address - Street 1:2400 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5323
Practice Address - Country:US
Practice Address - Phone:203-362-3900
Practice Address - Fax:203-362-3919
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001219101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)