=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265038061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM HARRY BENTLEY LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2020
-----------------------------------------------------
Last Update Date | 03/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 STONEY HILL RD
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02777-3919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-480-8913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 STONEY HILL RD
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02777-3919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-480-8913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 000226376
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 000226376
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------