Provider Demographics
NPI:1811139207
Name:BENNETT, JEAN MARIE (CAC2)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CAC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 COOK ST
Mailing Address - Street 2:#202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1839
Mailing Address - Country:US
Mailing Address - Phone:303-955-1606
Mailing Address - Fax:
Practice Address - Street 1:1555 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1614
Practice Address - Country:US
Practice Address - Phone:303-504-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)