Provider Demographics
NPI:1205934080
Name:BENTLEY, MARY E (SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:MINERVINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:2416 CONSTITUTION AVE
Mailing Address - Street 2:REHABILITATION TODAY SERVICES
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-372-2808
Mailing Address - Fax:716-372-2902
Practice Address - Street 1:2416 CONSTITUTION AVE
Practice Address - Street 2:REHABILITATION TODAY SERVICES
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-372-2808
Practice Address - Fax:716-372-2902
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026562601OtherUNIVERA
000000080693OtherGHI
4999810OtherGHI
9212131OtherINDEPENDENT HEALTH
NY02444622Medicaid
C=000640206002OtherCOMMUNITY BLUE
O=000640206001OtherWNYBCBS