Provider Demographics
NPI:1447794821
Name:BENT, MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
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 1:191 JORALEMON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4306
Mailing Address - Country:US
Mailing Address - Phone:929-268-3313
Mailing Address - Fax:
Practice Address - Street 1:191 JORALEMON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4306
Practice Address - Country:US
Practice Address - Phone:929-268-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health