MEDICARE: MS. AMORELLE BENNETT LCSW-R

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	R045210	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	045210-A37	OTHER	NY	HEALTHFIRST
2	NF0861	OTHER		BLUESHIELD/BLUECROSS

General Provider Information

NPI Number	:	1710134119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMORELLE BENNETT LCSW-R

Provider Business Mailing Address
First Line	:	2817 W 30TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 W 30TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1803
Country	:	US
Telephone Number	:	718-372-2277
Fax Number	:

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

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	08/27/2008

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