Provider Demographics
NPI:1245730480
Name:BENNETT, MAE (LISW)
Entity type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SOM CENTER RD STE D20
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2967
Mailing Address - Country:US
Mailing Address - Phone:440-681-9981
Mailing Address - Fax:
Practice Address - Street 1:6200 SOM CENTER RD STE D20
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2967
Practice Address - Country:US
Practice Address - Phone:440-681-9981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19014521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical