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General NPI Number Information
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NPI Number | 1720233737
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Entity Type | Individual
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Provider Name | ANGELA BENNETT MSW
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Gender | Female
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 510 BUTLER AVE
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City | MARTINSBURG
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State | WV
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Zip | 25405-9990
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Country | US
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Telephone | 301-263-0811
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Fax |
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Provider Business Mailing Address
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Address Line | 2687 WILLIAMSPORT PIKE
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City | MARTINSBURG
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State | WV
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Zip | 25404-6405
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Country | US
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Telephone | 304-267-1442
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | BP00943632
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License Number State | WV
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