Provider Demographics
NPI:1245378579
Name:BENNER, BEVERLY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANN
Last Name:BENNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:ANN
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:850 NORTH HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-268-2377
Practice Address - Street 1:901 S HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1923
Practice Address - Country:US
Practice Address - Phone:574-457-4400
Practice Address - Fax:574-457-4141
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005119A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
112989615OtherUBH
000000490536OtherANTHEM
IN100113330Medicaid
227270AMedicare ID - Type Unspecified
000000490536OtherANTHEM