Provider Demographics
NPI:1588944797
Name:BETTENCOURT, MARY ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:BETTENCOURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:MA
Mailing Address - Zip Code:01504
Mailing Address - Country:US
Mailing Address - Phone:508-883-5818
Mailing Address - Fax:508-883-5819
Practice Address - Street 1:8 BUTLER STREET
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:MA
Practice Address - Zip Code:01504
Practice Address - Country:US
Practice Address - Phone:508-883-5810
Practice Address - Fax:508-883-5819
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW01438104100000X
MA218886104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker