Provider Demographics
NPI:1710168679
Name:BENNINK, RICHARD (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BENNINK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CROW HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1118
Mailing Address - Country:US
Mailing Address - Phone:860-862-6235
Mailing Address - Fax:
Practice Address - Street 1:5 CROW HILL RD
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1118
Practice Address - Country:US
Practice Address - Phone:860-862-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical