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General NPI Number Information
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NPI Number | 1023150901
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Entity Type | Individual
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Provider Name | KENNETH ALVIN BENNETT JR. LCSW, CART
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 610 S INDUSTRIAL BLVD SUITE 307
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City | EULESS
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State | TX
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Zip | 76040-5048
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Country | US
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Telephone | 817-917-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 610 S INDUSTRIAL BLVD 307
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City | EULESS
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State | TX
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Zip | 76040-5048
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Country | US
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Telephone | 817-917-2335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 50547
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License Number State | TX
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