Provider Demographics
NPI:1629237698
Name:BENNETT, KERRY KATHRYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:KATHRYN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W FRONT ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1155
Mailing Address - Country:US
Mailing Address - Phone:732-859-2126
Mailing Address - Fax:
Practice Address - Street 1:210 W FRONT ST
Practice Address - Street 2:SUITE 209
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1155
Practice Address - Country:US
Practice Address - Phone:732-859-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053046001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical