| Doctor Name: | BETTY L FORTUIN |
| NPI Number: | 1144576505 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LC14392 |
| Business Practice Address: | 1000 Shore Rd Bldg #326 Cape Elizabeth, ME - 041071916 |
| Business Phone Number: | 2079395270 |
| Business Fax Number: | |
| Mailing Address: | 860 Highland Ave, SOUTH PORTLAND |
| State: | ME |
| Postal Code: | 041066831 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/03/2012 |
| NPI Last Update Date: | 04/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LC14392 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |