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General NPI Number Information
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NPI Number | 1083223069
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Entity Type | Individual
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Provider Name | DENISE LORRAINE BENNETT LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5180
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Country | US
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Telephone | 505-265-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 714 TOWNER AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-1037
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Country | US
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Telephone | 505-508-7668
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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 | C-10647
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License Number State | NM
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