Provider Demographics
NPI:1932398328
Name:BOFFOLI-BENTZEN, ANNE (LCSWR)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BOFFOLI-BENTZEN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:L
Other - Last Name:BOFFOLI BENTZEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW PLLC
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0486641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNG9321Medicare PIN