Provider Demographics
NPI:1649813551
Name:BENNETT, CARLA MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4283
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-4283
Mailing Address - Country:US
Mailing Address - Phone:509-669-8490
Mailing Address - Fax:
Practice Address - Street 1:1380 EASTMONT AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4286
Practice Address - Country:US
Practice Address - Phone:509-699-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical