Provider Demographics
NPI:1427168657
Name:BENTLEY, MARYBETH (BSW)
Entity type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0160
Mailing Address - Country:US
Mailing Address - Phone:360-678-5555
Mailing Address - Fax:360-678-3636
Practice Address - Street 1:390 NE MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2642
Practice Address - Country:US
Practice Address - Phone:360-678-5555
Practice Address - Fax:360-678-3636
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00021664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARC00021664OtherREGISTERED COUNSELOR