Provider Demographics
NPI:1770883399
Name:BENNETT, KRISTEN KATHLEEN (LMSWCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:KATHLEEN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMSWCC
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:KATHLEEN
Other - Last Name:CHISHOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSWCC
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4761
Mailing Address - Country:US
Mailing Address - Phone:207-210-3930
Mailing Address - Fax:208-887-7130
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4761
Practice Address - Country:US
Practice Address - Phone:207-210-3931
Practice Address - Fax:207-887-7130
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME126861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical