Provider Demographics
NPI:1033468954
Name:BENTLEY, NOLITA (MSW, PPSC)
Entity Type:Individual
Prefix:
First Name:NOLITA
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:MSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4536
Mailing Address - Country:US
Mailing Address - Phone:510-874-3710
Mailing Address - Fax:510-874-3707
Practice Address - Street 1:2850 WEST STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4536
Practice Address - Country:US
Practice Address - Phone:510-874-3710
Practice Address - Fax:510-874-3707
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool