Provider Demographics
NPI:1316568769
Name:BENNETT, AMY (MSW LSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GRABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3555 BUTZ RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9744
Mailing Address - Country:US
Mailing Address - Phone:419-367-2982
Mailing Address - Fax:
Practice Address - Street 1:22897 US HIGHWAY 20A
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-9138
Practice Address - Country:US
Practice Address - Phone:419-445-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0025617104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker