MEDICARE: DR. NORMAN RAY BENTSON PSYD

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	103TC0700X	Clinical Psychologist	24747	CA

General Provider Information

NPI Number	:	1588935100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN RAY BENTSON PSYD

Provider Business Mailing Address
First Line	:	112 HARVARD AVE # 3
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4716
Country	:	US
Telephone Number	:	909-455-5831
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 HARVARD AVE # 3
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4716
Country	:	US
Telephone Number	:	909-455-5831
Fax Number	:

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

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	02/14/2012

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