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General NPI Number Information
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NPI Number | 1356078208
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Entity Type | Individual
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Provider Name | SHANA BENNETT LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 9405 DOWDEN RD
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City | ORLANDO
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State | FL
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Zip | 32832-5612
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Country | US
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Telephone | 551-900-1519
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Fax |
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Provider Business Mailing Address
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Address Line | 6441 S CHICKASAW TRL # 193
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City | ORLANDO
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State | FL
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Zip | 32829-8366
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Country | US
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Telephone | 551-900-1519
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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 | 19934
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 091969
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License Number State | NY
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