Healthcare Provider Details

I. General information

NPI: 1447486147
Provider Name (Legal Business Name): SHEREEN RIA CABRERA BENTLEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7178 COLUMBIA GATEWAY DR
COLUMBIA MD
21046-2581
US

IV. Provider business mailing address

8930 STANFORD BLVD
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-6202
  • Fax:
Mailing address:
  • Phone: 410-313-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberG10817
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: