Individual
AUDREY L BENNETT
Active
Individual
AUDREY L BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000729
CT
104100000X
Social Worker
006194
CT
1041C0700X
Clinical Social Worker
Primary
006194
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004262945
—
CT
05
—
006194
—
CT
05
—
1041C0700X
—
MD
Enumeration date
08/30/2006
Last updated
01/27/2025
Update your record
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