Provider Demographics
NPI:1740417237
Name:BENNETT, AMBER M (LMSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 HECLA ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1212
Mailing Address - Country:US
Mailing Address - Phone:906-482-4250
Mailing Address - Fax:
Practice Address - Street 1:809 HECLA ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1212
Practice Address - Country:US
Practice Address - Phone:906-482-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081230104100000X
NY0807061041C0700X
MI68010964831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker