Provider Demographics
NPI:1356686174
Name:BENNETT, CHELSEY RENEE
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:RENEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 W PONTIAC WAY
Mailing Address - Street 2:APT. 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4579
Mailing Address - Country:US
Mailing Address - Phone:559-978-2429
Mailing Address - Fax:
Practice Address - Street 1:3024 W PONTIAC WAY
Practice Address - Street 2:APT. 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4579
Practice Address - Country:US
Practice Address - Phone:559-978-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool