MEDICARE: BARBARA CHARLOTTE BENTLEY LCSW-C

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	14022	MD

General Provider Information

NPI Number	:	1578821120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA CHARLOTTE BENTLEY LCSW-C

Provider Business Mailing Address
First Line	:	PSC 561 PO BOX 655
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96310-0007
Country	:	US
Telephone Number	:	08046621311
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 561 BOX 1877
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96310-0019
Country	:	US
Telephone Number	:	82-779-6396
Fax Number	:

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

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	08/08/2013

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