Healthcare Provider Details

I. General information

NPI: 1154697548
Provider Name (Legal Business Name): CLARICE BENNETT HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 L ST NW SUITE 900
WASHINGTON DC
20036-4201
US

IV. Provider business mailing address

7611 EASTERN AVE APT 104
SILVER SPRING MD
20912-4004
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-1111
  • Fax:
Mailing address:
  • Phone: 301-588-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: