Provider Demographics
NPI:1942974118
Name:BENNETT, GERALD ERIC (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ERIC
Last Name:BENNETT
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:GERALD
Other - Middle Name:ERIC
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THERAPIST
Mailing Address - Street 1:22125 96TH PL S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1947
Mailing Address - Country:US
Mailing Address - Phone:120-633-4333
Mailing Address - Fax:
Practice Address - Street 1:2800 E MADISON ST STE 306
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4865
Practice Address - Country:US
Practice Address - Phone:844-701-1080
Practice Address - Fax:844-701-1085
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA605853101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical