Provider Demographics
NPI:1417442658
Name:BAMBENEK, RICHARD CLEMENTE
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CLEMENTE
Last Name:BAMBENEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 NW STONECREST CT
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-1770
Mailing Address - Country:US
Mailing Address - Phone:816-510-4196
Mailing Address - Fax:
Practice Address - Street 1:529 SE 2ND ST STE D
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2654
Practice Address - Country:US
Practice Address - Phone:816-581-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor