Individual
JEAN C BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
56 WILLIAM ST, PORTLAND, ME 04103-4828
(207) 773-5057
Mailing address
PO BOX 8226, PORTLAND, ME 04104-8226
(207) 773-5057
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1005
ME
Other
Enumeration date
01/11/2008
Last updated
01/11/2008
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