Provider Demographics
NPI:1972604932
Name:BENNETT, SHARI JAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:JAN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1857
Mailing Address - Country:US
Mailing Address - Phone:978-486-8104
Mailing Address - Fax:978-486-8104
Practice Address - Street 1:438 KING ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1269
Practice Address - Country:US
Practice Address - Phone:978-692-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1056901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA103968Medicare UPIN
MAPO 3665Medicare UPIN
MA713329Medicare UPIN
MAPO 3665Medicare ID - Type Unspecified