Provider Demographics
NPI:1568486009
Name:BENTSEN, ADRIENNE JOHANSON (MA)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:JOHANSON
Last Name:BENTSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2324
Mailing Address - Country:US
Mailing Address - Phone:207-200-3055
Mailing Address - Fax:
Practice Address - Street 1:602 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2324
Practice Address - Country:US
Practice Address - Phone:207-200-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60032208101YM0800X
MEMF5107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1568486009OtherNPI