Healthcare Provider Details

I. General information

NPI: 1457467888
Provider Name (Legal Business Name): ARTHUR LOGAN BENCE MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 HARBOR HILLS ROAD
CENTERVILLE MA
02632
US

IV. Provider business mailing address

PO BOX 274
WEST HYANNISPORT MA
02672-0274
US

V. Phone/Fax

Practice location:
  • Phone: 508-776-4589
  • Fax:
Mailing address:
  • Phone: 508-776-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1017469
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: