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General NPI Number Information
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NPI Number | 1245532639
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Entity Type | Organization
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Legal Business Name | ANNE L BOFFOLI BENTZEN LCSW PLLC
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 01/08/2017
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Provider Practice Location Address
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Address Line | 153 DUKE DR
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City | CARMEL
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State | NY
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Zip | 10512-1598
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Country | US
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Telephone | 845-519-5415
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Fax |
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Provider Business Mailing Address
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Address Line | 153 DUKE DR
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City | CARMEL
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State | NY
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Zip | 10512-1598
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Country | US
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Telephone | 845-519-5415
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Fax |
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Authorized Official
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Title or Position | SOLE MANAGING MEMBER OF PLLC
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Name | ANNE L BOFFOLI BENTZEN LCSW PLLC
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Credential | LCSW
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Telephone | 845-519-5415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | R048664-1
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License Number State | NY
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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 | R048664-1
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License Number State | NY
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