Healthcare Provider Details

I. General information

NPI: 1285846188
Provider Name (Legal Business Name): ANGELA M. BENGIS LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 HALF HOLLOW RD
DIX HILLS NY
11746-5861
US

IV. Provider business mailing address

157 GILLER AVE
HOLBROOK NY
11741-3214
US

V. Phone/Fax

Practice location:
  • Phone: 631-286-6928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076902
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070794-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: