Individual
MR. MATTHEW GEORGE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
284 MARTIN ST, TWIN FALLS, ID 83301-4542
(925) 321-8603
Mailing address
284 MARTIN ST, TWIN FALLS, ID 83301-4542
(925) 321-8603
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-31382
ID
Other
Enumeration date
06/16/2011
Last updated
06/16/2011
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