Healthcare Provider Details

I. General information

NPI: 1003701087
Provider Name (Legal Business Name): SIMONA G BENTSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1707
US

IV. Provider business mailing address

281 PORT RICHMOND AVE FL 2
STATEN ISLAND NY
10302-1707
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-6006
  • Fax:
Mailing address:
  • Phone: 718-442-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4184977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: