Provider Demographics
NPI:1619072832
Name:BENNETT, JUDITH ANN (LCSW, LMHP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8599
Mailing Address - Country:US
Mailing Address - Phone:308-237-1086
Mailing Address - Fax:308-237-1013
Practice Address - Street 1:1011 E 53RD ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8599
Practice Address - Country:US
Practice Address - Phone:308-237-1086
Practice Address - Fax:308-237-1013
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253301-00Medicaid
NE100253301-00Medicaid
NER29827Medicare UPIN