Provider Demographics
NPI:1164121331
Name:BENNETT, ADAM PRESLAV (LMSW)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PRESLAV
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 E ESTES WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5571
Mailing Address - Country:US
Mailing Address - Phone:480-338-2655
Mailing Address - Fax:
Practice Address - Street 1:1110 E MISSOURI AVE STE 760
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2737
Practice Address - Country:US
Practice Address - Phone:602-918-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-211281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical