Provider Demographics
NPI:1164161642
Name:BENNETT, TAYLOR (LMSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NEWMAN DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4221
Mailing Address - Country:US
Mailing Address - Phone:315-767-0018
Mailing Address - Fax:
Practice Address - Street 1:401 NEWMAN DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4221
Practice Address - Country:US
Practice Address - Phone:315-767-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1465549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health