Provider Demographics
NPI:1417773003
Name:BENNETT, PASSION J J (LSW)
Entity type:Individual
Prefix:
First Name:PASSION
Middle Name:J J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1417
Mailing Address - Country:US
Mailing Address - Phone:856-678-9400
Mailing Address - Fax:856-678-9401
Practice Address - Street 1:601 BRIDGETON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-4810
Practice Address - Country:US
Practice Address - Phone:856-825-0255
Practice Address - Fax:856-678-9401
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07169800101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health