Provider Demographics
NPI:1942618640
Name:BENNETT, ELENA SOLANO (LCSW)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:SOLANO
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 1:4101 MEDICAL PKWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3734
Mailing Address - Country:US
Mailing Address - Phone:512-222-9701
Mailing Address - Fax:512-201-2991
Practice Address - Street 1:4101 MEDICAL PKWY
Practice Address - Street 2:SUITE 109
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3734
Practice Address - Country:US
Practice Address - Phone:512-222-9701
Practice Address - Fax:512-201-2991
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX556531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
46-5771165OtherEIN