Provider Demographics
NPI:1306684147
Name:BENNETT, JULIE K
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 LA GRANDE AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1620
Mailing Address - Country:US
Mailing Address - Phone:908-447-8228
Mailing Address - Fax:
Practice Address - Street 1:181 LA GRANDE AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1620
Practice Address - Country:US
Practice Address - Phone:908-447-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06200200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker