Individual
MS. AUDREY P BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
30 HEMPSTEAD AVE, SUITE 152, ROCKVILLE CENTRE, NY 11750
(516) 433-4243
Mailing address
10 STEUBEN DR, JERICHO, NY 11753-1441
(516) 433-4243
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R025833
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035927
PIN
—
05
—
61017394957
—
NY
Enumeration date
12/14/2006
Last updated
07/08/2007
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