Provider Demographics
NPI:1720736713
Name:BENNETT, KEVIN DONNELL (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DONNELL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 E MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2901
Mailing Address - Country:US
Mailing Address - Phone:267-273-5899
Mailing Address - Fax:
Practice Address - Street 1:401 E HUNTING PARK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-6008
Practice Address - Country:US
Practice Address - Phone:215-427-4750
Practice Address - Fax:215-425-3688
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0205111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical