Provider Demographics
NPI:1891705174
Name:BENNETT, RACHEL ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
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:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-0095
Mailing Address - Country:US
Mailing Address - Phone:207-624-1342
Mailing Address - Fax:
Practice Address - Street 1:137 TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1845
Practice Address - Country:US
Practice Address - Phone:207-624-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC109961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431729599Medicaid