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General NPI Number Information
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NPI Number | 1588233761
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Entity Type | Organization
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Legal Business Name | LENA BENNET LCSW LLC
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 6617 VOOSCANE AVE
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City | COCHITI LAKE
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State | NM
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Zip | 87083-6003
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Country | US
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Telephone | 505-934-6558
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1363
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City | PENA BLANCA
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State | NM
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Zip | 87041-1363
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Country | US
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Telephone | 505-934-6558
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MADELEINE BENNET
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Credential | LCSW
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Telephone | 505-796-4210
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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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