Provider Demographics
NPI:1245532639
Name:ANNE L BOFFOLI BENTZEN LCSW PLLC
Entity type:Organization
Organization Name:ANNE L BOFFOLI BENTZEN LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGING MEMBER OF PLLC
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOFFOLI BENTZEN LCSW PLLC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-519-5415
Mailing Address - Street 1:153 DUKE DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1598
Mailing Address - Country:US
Mailing Address - Phone:845-519-5415
Mailing Address - Fax:
Practice Address - Street 1:153 DUKE DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-1598
Practice Address - Country:US
Practice Address - Phone:845-519-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048664-1261QM0801X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNG9321Medicare UPIN