Provider Demographics
NPI:1689033805
Name:BENNETT, LINDSEY KOMARA (LCSW, MCAP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:KOMARA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4947
Mailing Address - Country:US
Mailing Address - Phone:386-316-0836
Mailing Address - Fax:
Practice Address - Street 1:100 N LAURA ST STE 800
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3668
Practice Address - Country:US
Practice Address - Phone:904-762-4122
Practice Address - Fax:904-758-5315
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW123191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical