Provider Demographics
NPI:1316012479
Name:BENNETT, JAMES M (LICSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MASSACHUSETTS AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6732
Mailing Address - Country:US
Mailing Address - Phone:781-488-0099
Mailing Address - Fax:781-646-1066
Practice Address - Street 1:366 MASSACHUSETTS AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6732
Practice Address - Country:US
Practice Address - Phone:781-488-0099
Practice Address - Fax:781-646-1066
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03996OtherBCBS OF MA
MAP03996OtherBCBS OF MA