MEDICARE: ANNA L PRESPARE BENNETT LCSW-R

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	00076352	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	J400000216	OTHER		MEDICARE SENIOR BLUE

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000415214001	OTHER	EMPIRE BC/BS BLUE CARD
2	000415214001	OTHER	HEALTH NOW
3	11645160	OTHER	CAQH
4	000415214001	OTHER	BLUE SHIELD OF NORTHEASTERN NY
5	000415214001	OTHER	EMPIRE BC/BS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	53088	OTHER	MVP

NPI Number	:	1154349280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA L PRESPARE BENNETT LCSW-R

Provider Business Mailing Address
First Line	:	3043 STATE ROUTE 4
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-9632
Country	:	US
Telephone Number	:	518-747-2284
Fax Number	:	518-747-2253

Provider Business Practice Location Address
First Line	:	3043 STATE ROUTE 4
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-9632
Country	:	US
Telephone Number	:	518-747-2284
Fax Number	:	518-747-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/07/2011

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

3043 STATE ROUTE 4
HUDSON FALLS, NY
12839-9632