Provider Demographics
NPI:1679168371
Name:MORAN, BETHANY M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:M
Last Name:MORAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:M
Other - Last Name:WARICKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:17595 S TAMIAMI TRL STE 225
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4819
Mailing Address - Country:US
Mailing Address - Phone:239-898-0094
Mailing Address - Fax:239-362-2466
Practice Address - Street 1:17595 S TAMIAMI TRL STE 225
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4819
Practice Address - Country:US
Practice Address - Phone:239-898-0094
Practice Address - Fax:239-362-2466
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW153481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical