Provider Demographics
NPI:1295320083
Name:LLC OF REGINA BENNER
Entity type:Organization
Organization Name:LLC OF REGINA BENNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, RPT
Authorized Official - Phone:215-407-5232
Mailing Address - Street 1:109 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3108
Mailing Address - Country:US
Mailing Address - Phone:121-540-7523
Mailing Address - Fax:
Practice Address - Street 1:672A KNOWLES AVE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4102
Practice Address - Country:US
Practice Address - Phone:215-407-5232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty