Healthcare Provider Details

I. General information

NPI: 1730199548
Provider Name (Legal Business Name): JULIE KUGLER-BENTLEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S PROSPECT ST
HAGERSTOWN MD
21740-5409
US

IV. Provider business mailing address

113 S PROSPECT ST
HAGERSTOWN MD
21740-5409
US

V. Phone/Fax

Practice location:
  • Phone: 240-301-9464
  • Fax: 301-745-4110
Mailing address:
  • Phone: 240-301-9464
  • Fax: 301-745-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07998
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: