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General NPI Number Information
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NPI Number | 1295320083
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Entity Type | Organization
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Legal Business Name | LLC OF REGINA BENNER
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 672A KNOWLES AVE
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-4102
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Country | US
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Telephone | 215-407-5232
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Fax |
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Provider Business Mailing Address
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Address Line | 109 SUMMIT AVE
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City | WILLOW GROVE
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State | PA
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Zip | 19090-3108
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Country | US
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Telephone | 121-540-7523
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Fax |
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Authorized Official
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Title or Position | OUTPATIENT THERAPIST
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Name | MRS. REGINA C BENNER
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Credential | MSW, LCSW, RPT
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Telephone | 215-407-5232
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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 |
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License Number State |
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