Provider Demographics
NPI:1013921485
Name:BENTLEY, DONALD PHILLIP (LCSW BCD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:PHILLIP
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 EL CAMINO REAL
Mailing Address - Street 2:SUITE 108 D
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6280
Mailing Address - Country:US
Mailing Address - Phone:760-722-1366
Mailing Address - Fax:760-757-6297
Practice Address - Street 1:2103 EL CAMINO REAL
Practice Address - Street 2:SUITE 108 D
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6280
Practice Address - Country:US
Practice Address - Phone:760-722-1366
Practice Address - Fax:760-757-6297
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS100401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ958132OtherBLUE SHIELD
R62859Medicare UPIN
10040Medicare ID - Type Unspecified