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NPI Code Detail

MEDICARE: MR. EDWIN TALCOTT BENNETT MSW-LCSW

MEDICARE: MR. EDWIN TALCOTT BENNETT MSW-LCSW
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1184667172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWIN TALCOTT BENNETT MSW-LCSW
Provider Business Mailing Address
First Line : 2028 N SEMINARY AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-2626
Country : US
Telephone Number : 815-333-8651
Fax Number :
Provider Business Practice Location Address
First Line : 2028 N SEMINARY AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-2626
Country : US
Telephone Number : 815-333-8651
Fax Number : 815-337-4406
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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