Active NPI
Tracy Bennett, LBSW
- Clinical Social Worker
- Holland, MI
National Provider Identifier
1619449147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6802070790
- Practice address
- 12265 James St
Holland, MI 49424-8613 - Phone
- (616) 490-0561
- NPI assigned
- Dec 21, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6802070790 | MI | Primary |
Addresses
Primary practice location
12265 James St
Holland, MI 49424-8613
Mailing address
12265 James St
Holland, MI 49424-8613
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6802070790 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545350400000",
"number": "1619449147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12265 JAMES ST",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494248613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12265 JAMES ST",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494248613",
"telephone_number": "616-490-0561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "TRACY",
"credential": "LBSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-21",
"last_updated": "2018-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6802070790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.