Provider Demographics
NPI:1235291691
Name:BENNETT, GAIL DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:DENISE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW
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Other - Credentials:
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-2420
Mailing Address - Fax:706-787-8180
Practice Address - Street 1:DDEAMC 300 E HOSPITAL ROAD 13A-10
Practice Address - Street 2:BLDG. 40701
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-2420
Practice Address - Fax:706-787-8180
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACSW0025551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN