Provider Demographics
NPI:1114258993
Name:KENTISH BENNETT, DAWN P (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:P
Last Name:KENTISH BENNETT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:P
Other - Last Name:KENTISH BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCWS
Mailing Address - Street 1:297 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2287
Mailing Address - Country:US
Mailing Address - Phone:401-743-0408
Mailing Address - Fax:
Practice Address - Street 1:297 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-2287
Practice Address - Country:US
Practice Address - Phone:401-743-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW013801041C0700X, 104100000X
RIISW024151041C0700X
GACSW0058491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICSW01380OtherLICENSE