Provider Demographics
NPI:1235207168
Name:BENTLEY, NELSON G (PHD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:G
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-583-7256
Mailing Address - Fax:
Practice Address - Street 1:204 E JOPPA ROAD PH16
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-337-9441
Practice Address - Fax:410-339-7169
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01720103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
245893OtherMAMSI
6148825OtherUNITED BEHAVIORAL HEALTH
00874OtherVALUE OPTIONS
MD58050001OtherCARE FIRST BCBS
221724OtherCOMPSYCH
24097OtherJOHN HOPKINS EHP
MD581M897FMedicare ID - Type Unspecified
24097OtherJOHN HOPKINS EHP