Provider Demographics
NPI:1689017634
Name:BENDER, RITA M (PSYD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:BENDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 BROADWAY
Mailing Address - Street 2:17 FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4640
Mailing Address - Country:US
Mailing Address - Phone:212-851-8100
Mailing Address - Fax:212-537-0102
Practice Address - Street 1:1745 BROADWAY
Practice Address - Street 2:17 FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4640
Practice Address - Country:US
Practice Address - Phone:212-851-8100
Practice Address - Fax:212-537-0102
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019958103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02407243Medicaid
NYA400096829Medicare PIN