Provider Demographics
NPI:1811922180
Name:BENTIVEGNA, SANTO WILLIAM (PHD)
Entity type:Individual
Prefix:
First Name:SANTO
Middle Name:WILLIAM
Last Name:BENTIVEGNA
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 1:780 BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610
Mailing Address - Country:US
Mailing Address - Phone:585-288-2420
Mailing Address - Fax:585-288-2426
Practice Address - Street 1:780 BLOSSOM RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610
Practice Address - Country:US
Practice Address - Phone:585-288-2420
Practice Address - Fax:585-288-2426
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0008122103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPO10008122OtherBLUE CHOICE
7896311OtherAETNA
NY100256FCOtherPREFERRED CARE