Provider Demographics
NPI:1609621036
Name:BENNETT, SHARIFA S
Entity Type:Individual
Prefix:
First Name:SHARIFA
Middle Name:S
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 1:4920 COLONEL CONTEE PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2802
Mailing Address - Country:US
Mailing Address - Phone:678-596-2194
Mailing Address - Fax:
Practice Address - Street 1:4920 COLONEL CONTEE PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2802
Practice Address - Country:US
Practice Address - Phone:678-596-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical