Provider Demographics
NPI:1740234863
Name:BENNETT-BOWIE, GINA (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:BENNETT-BOWIE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 BELLONA LN
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2055
Mailing Address - Country:US
Mailing Address - Phone:410-821-7775
Mailing Address - Fax:410-821-1320
Practice Address - Street 1:8415 BELLONA LN
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2055
Practice Address - Country:US
Practice Address - Phone:410-821-7775
Practice Address - Fax:410-821-1320
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
K552M384Medicare UPIN
MDQ29861Medicare UPIN