Provider Demographics
NPI:1902183213
Name:BENNETT, LINDA DIANE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:DIANE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:471 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-2007
Mailing Address - Country:US
Mailing Address - Phone:413-733-1431
Mailing Address - Fax:413-732-0705
Practice Address - Street 1:471 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-2007
Practice Address - Country:US
Practice Address - Phone:413-733-1431
Practice Address - Fax:413-732-0705
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical