Healthcare Provider Details

I. General information

NPI: 1083002158
Provider Name (Legal Business Name): CARLY BENDZANS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ALBANY AVE # 1120
WEST HARTFORD CT
06117-2335
US

IV. Provider business mailing address

40 HILLCREST AVE
MIDDLETOWN CT
06457-5322
US

V. Phone/Fax

Practice location:
  • Phone: 508-272-2668
  • Fax:
Mailing address:
  • Phone: 860-784-7659
  • Fax: 860-935-6272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.016683
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number201911184NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number486
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: