Provider Demographics
NPI:1962178186
Name:LOGAN-BENNETT, CHRISTOPHER ALAN (LCSW-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:LOGAN-BENNETT
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 REGESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1916
Mailing Address - Country:US
Mailing Address - Phone:410-440-9336
Mailing Address - Fax:410-440-9336
Practice Address - Street 1:609 REGESTER AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1916
Practice Address - Country:US
Practice Address - Phone:410-440-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical