MEDICARE: LAUREN HENRIQUEZ-BENTINE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	079688	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	136167177	OTHER	NY	FIDELIS
2	13-5564937	OTHER	NY	JBFCS
3	079688	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1184754905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN HENRIQUEZ-BENTINE LCSW

Provider Business Mailing Address
First Line	:	1686 METROPOLITAN AVENUE
Second Line	:	APT MF
City	:	BRONX
State	:	NY
Zip	:	10462-6951
Country	:	US
Telephone Number	:	917-861-6211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 PELHAM S PKWY 3H
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1023
Country	:	US
Telephone Number	:	917-861-6211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/26/2015

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Directions to “ LAUREN HENRIQUEZ-BENTINE LCSW” Practice Location

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