Provider Demographics
NPI:1508921719
Name:BENNETT, CINDY (CYNTHIA) MARIE (M) (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CINDY (CYNTHIA)
Middle Name:MARIE (M)
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S NEWCASTLE RD.
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-0741
Mailing Address - Country:US
Mailing Address - Phone:308-390-9103
Mailing Address - Fax:
Practice Address - Street 1:1515 S NEWCASTLE RD.
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-0741
Practice Address - Country:US
Practice Address - Phone:308-390-9103
Practice Address - Fax:308-382-5315
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7310101YM0800X
NE63641041C0700X
NE1277101YM0800X
NE33621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025173100Medicaid
NE10025173100Medicaid