Individual
MRS. BEVERLY ANN BENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
901 S HUNTINGTON ST, SYRACUSE, IN 46567-1923
(574) 457-4400
(574) 457-4141
Mailing address
850 NORTH HARRISON STREET, WARSAW, IN 46580
(574) 267-7169
(574) 268-2377
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005119A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000490536
ANTHEM
—
05
—
100113330
—
IN
01
—
112989615
UBH
—
Enumeration date
02/01/2007
Last updated
11/05/2010
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