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General NPI Number Information
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NPI Number | 1962731984
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Entity Type | Organization
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Legal Business Name | ROBERTA G. BENNETT, MA MSW LCSW LLC
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Dates
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Enumeration Date | 12/22/2009
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 1810 WELLNESS LN
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-5357
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Country | US
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Telephone | 727-375-8870
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Fax | 727-376-4141
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Provider Business Mailing Address
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Address Line | 1810 WELLNESS LN
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-5357
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Country | US
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Telephone | 727-375-8870
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Fax | 727-376-4141
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAURA LAURA
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Credential |
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Telephone | 727-375-8870
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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 | SW7105
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License Number State | FL
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