Provider Demographics
NPI:1427204460
Name:BENEKE, BONNIE S (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:S
Last Name:BENEKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 BRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5821
Mailing Address - Country:US
Mailing Address - Phone:615-838-0201
Mailing Address - Fax:
Practice Address - Street 1:2802 BRIGHTWOOD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5821
Practice Address - Country:US
Practice Address - Phone:615-838-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP 6761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical