Provider Demographics
NPI:1548523970
Name:BENT, DEBBIE M
Entity type:Individual
Prefix:MISS
First Name:DEBBIE
Middle Name:M
Last Name:BENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 BATH AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4507
Mailing Address - Country:US
Mailing Address - Phone:646-852-4221
Mailing Address - Fax:
Practice Address - Street 1:1639 BATH AVE
Practice Address - Street 2:APT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4507
Practice Address - Country:US
Practice Address - Phone:646-852-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist