MEDICARE: JANINE MICHELLE BENNETT CAC I

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CACI1097	DC

General Provider Information

NPI Number	:	1629753462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANINE MICHELLE BENNETT CAC I

Provider Business Mailing Address
First Line	:	655 JEFFERSON ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2642
Country	:	US
Telephone Number	:	202-276-3152
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6912
Country	:	US
Telephone Number	:	202-610-1886
Fax Number	:

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

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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