Individual
THERESA L BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2911
Mailing address
190 RIVERSIDE ST, SUITE 6B, PORTLAND, ME 04103-1073
(207) 661-2000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC4858
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
304630099
—
ME
Enumeration date
03/15/2007
Last updated
04/27/2017
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