Provider Demographics
NPI:1093824294
Name:BENNETT, AUDREY L (LCSW, LADC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:L
Other - Last Name:SCOVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8901 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-400-1295
Mailing Address - Fax:301-319-8630
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5001
Practice Address - Country:US
Practice Address - Phone:860-819-8570
Practice Address - Fax:301-319-8630
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000729101YA0400X
CT006194104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004262945Medicaid
CT006194Medicaid
MD1041C0700XMedicaid