Provider Demographics
NPI:1811025927
Name:BENNETT, DANA S (MSW LICSW BCD)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:S
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MSW LICSW BCD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MAE
Other - Last Name:SILVERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1065 MILLSTONE RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631
Mailing Address - Country:US
Mailing Address - Phone:508-896-5890
Mailing Address - Fax:508-896-6594
Practice Address - Street 1:1065 MILLSTONE RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2615
Practice Address - Country:US
Practice Address - Phone:508-896-5890
Practice Address - Fax:508-896-6594
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03374Medicare ID - Type Unspecified