Provider Demographics
NPI:1194484584
Name:BENTLEY, TIFFANY ELIZABETH
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:BENTLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 HAVRE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-3084
Mailing Address - Country:US
Mailing Address - Phone:305-968-6109
Mailing Address - Fax:
Practice Address - Street 1:18463 SW 87TH PL
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7268
Practice Address - Country:US
Practice Address - Phone:860-681-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT153.0133907104100000X
MA2268741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker