Provider Demographics
NPI:1134203185
Name:BENDO, JOSEPH J (PHD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:BENDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S MILLER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4141
Mailing Address - Country:US
Mailing Address - Phone:234-260-4200
Mailing Address - Fax:234-334-5738
Practice Address - Street 1:66 S MILLER RD STE 103
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4141
Practice Address - Country:US
Practice Address - Phone:234-260-4200
Practice Address - Fax:234-334-5738
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3852103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist