Provider Demographics
NPI:1588233761
Name:LENA BENNET LCSW LLC
Entity Type:Organization
Organization Name:LENA BENNET LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-796-4210
Mailing Address - Street 1:PO BOX 1363
Mailing Address - Street 2:
Mailing Address - City:PENA BLANCA
Mailing Address - State:NM
Mailing Address - Zip Code:87041-1363
Mailing Address - Country:US
Mailing Address - Phone:505-934-6558
Mailing Address - Fax:
Practice Address - Street 1:6617 VOOSCANE AVE
Practice Address - Street 2:
Practice Address - City:COCHITI LAKE
Practice Address - State:NM
Practice Address - Zip Code:87083-6003
Practice Address - Country:US
Practice Address - Phone:505-934-6558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76908551Medicaid