Provider Demographics
NPI:1598881609
Name:BENNETT-CLEAR, WHITNEY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:
Last Name:BENNETT-CLEAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 VERANO LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8351
Mailing Address - Country:US
Mailing Address - Phone:505-466-3041
Mailing Address - Fax:
Practice Address - Street 1:7 VERANO LOOP
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8351
Practice Address - Country:US
Practice Address - Phone:505-466-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-057921041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12187755Medicaid