Provider Demographics
NPI:1619985793
Name:BENNETT, TRINA LYNN (LGSW)
Entity Type:Individual
Prefix:MS
First Name:TRINA
Middle Name:LYNN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8430 COTONEASTER DR
Mailing Address - Street 2:2E
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7254
Mailing Address - Country:US
Mailing Address - Phone:301-938-1800
Mailing Address - Fax:
Practice Address - Street 1:7702 DUNMANWAY
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-5436
Practice Address - Country:US
Practice Address - Phone:410-282-1792
Practice Address - Fax:410-282-3195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG120621041C0700X
PASW1248611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical