Bennett, Audrey L
Bennett, Audrey L is an sole proprietor health care provider with primary practice located at 1 Jarrett White Rd , Tripler Amc HI 96859-5001. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Bennett, Audrey L can be contacted via phone (860) 819-8570.Contact Information
Primary practice address
1 Jarrett White Rd
Tripler Amc HI 96859-5001
Phone: (860) 819-8570
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 000729 | Connecticut |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 006194 | Connecticut |
Profile Details
| NPI number | 1093824294 |
|---|---|
| LBN Legal business name | Bennett, Audrey L |
| Credentials | LCSW, LADC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 30th, 2006 |
| Last updated | Nov 4th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093824294 | NPPES |
| Connecticut | MEDICAID | 004262945 |
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