1194772392 NPI number — JOAL ANN BENNETT-STENZEL MSW,LCSW-C, LICSW

Table of content: JOAL ANN BENNETT-STENZEL MSW,LCSW-C, LICSW (NPI 1194772392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194772392 NPI number — JOAL ANN BENNETT-STENZEL MSW,LCSW-C, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT-STENZEL
Provider First Name:
JOAL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW,LCSW-C, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENNETT-BLACKMON
Provider Other First Name:
JOAL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW,LCSW-C,LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194772392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7806 TURNING CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-4076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-523-4218
Provider Business Mailing Address Fax Number:
301-765-7024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14816 PHYSICIANS LN
Provider Second Line Business Practice Location Address:
SUITE 252
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-523-4218
Provider Business Practice Location Address Fax Number:
301-765-7024
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  10646 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LC00301872 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 349147 . This is a "OPTIMUM CHOICE, UHC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2307-0018 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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