MEDICARE: MISS FELICIA BENNETT LGSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	57604	TX

General Provider Information

NPI Number	:	1568725463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS FELICIA BENNETT LGSW

Provider Business Mailing Address
First Line	:	14 SOMMERSET DR
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36869-5709
Country	:	US
Telephone Number	:	334-520-7319
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 SOMMERSET DR
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36869-5709
Country	:	US
Telephone Number	:	334-520-7319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2012
Last Update Date	:	06/30/2025

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