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General NPI Number Information
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NPI Number | 1194484584
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Entity Type | Individual
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Provider Name | TIFFANY ELIZABETH BENTLEY
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Gender | Female
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 18463 SW 87TH PL
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City | CUTLER BAY
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State | FL
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Zip | 33157-7268
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Country | US
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Telephone | 860-681-5945
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Fax |
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Provider Business Mailing Address
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Address Line | 218 HAVRE ST APT 3
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City | BOSTON
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State | MA
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Zip | 02128-3084
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Country | US
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Telephone | 305-968-6109
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 153.0133907
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 226874
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License Number State | MA
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