NPI 1821611005 · live from the CMS NPI Registry
Tina Bennett, LICSW
Social Worker, Clinical in Clarksburg, WV. National Provider Identifier 1821611005, active.
NPI record
| NPI | 1821611005 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 1 Medical Center Dr, Clarksburg, WV 26301 |
| Practice phone | 304-623-3461 |
| Mailing address | 205 High St, Jane Lew, WV 26378 |
| Enumerated | May 22, 2020 |
| Last updated | May 22, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Social Worker, Clinical primary | 1041C0700X | DP00941494 (WV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.