MEDICARE: CAROLINE BENTLEY

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	106H00000X	Marriage & Family Therapist	53426	CA

General Provider Information

NPI Number	:	1528376456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE BENTLEY

Provider Business Mailing Address
First Line	:	8788 ELK GROVE BLVD STE O
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1768
Country	:	US
Telephone Number	:	747-777-0623
Fax Number	:

Provider Business Practice Location Address
First Line	:	8788 ELK GROVE BLVD STE O
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1768
Country	:	US
Telephone Number	:	477-770-6237
Fax Number	:

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

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	06/29/2021

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Directions to “ CAROLINE BENTLEY ” Practice Location

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