Provider Demographics
NPI:1841582418
Name:BENNETT, SHEILA
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:16210 JAMAICA AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4927
Mailing Address - Country:US
Mailing Address - Phone:718-454-2700
Mailing Address - Fax:
Practice Address - Street 1:16210 JAMAICA AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4927
Practice Address - Country:US
Practice Address - Phone:718-454-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083712-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker