MEDICARE: LINDSEY KOMARA BENNETT LCSW, MCAP

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	1041C0700X	Clinical Social Worker	SW12319	FL

General Provider Information

NPI Number	:	1689033805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY KOMARA BENNETT LCSW, MCAP

Provider Business Mailing Address
First Line	:	4811 RAMONA BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-4947
Country	:	US
Telephone Number	:	386-316-0836
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N LAURA ST STE 800
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-3668
Country	:	US
Telephone Number	:	904-762-4122
Fax Number	:	904-758-5315

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

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	06/14/2021

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