Provider Demographics
NPI:1154853612
Name:BENTLEY, PATTIE ELAINE (BCBA)
Entity Type:Individual
Prefix:
First Name:PATTIE
Middle Name:ELAINE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 VILLAGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1963
Mailing Address - Country:US
Mailing Address - Phone:613-335-5681
Mailing Address - Fax:
Practice Address - Street 1:1645 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5428
Practice Address - Country:US
Practice Address - Phone:877-999-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst