Provider Demographics
NPI:1902060924
Name:KITNICK, BETTE ALEXANDER (MFT)
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:ALEXANDER
Last Name:KITNICK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 COUNTRYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5401
Mailing Address - Country:US
Mailing Address - Phone:760-889-3534
Mailing Address - Fax:
Practice Address - Street 1:741 GARDEN VIEW CT
Practice Address - Street 2:#210
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2470
Practice Address - Country:US
Practice Address - Phone:760-889-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC022024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist