Tina Bennett, LICSW
Individual provider Active NPI Clinical Social Worker · Clarksburg, WV
NPI 1821611005 · NPPES record last updated May 22, 2020
Key facts
- NPI
- 1821611005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- DP00941494 (WV)
- Practice address
- 1 Medical Center Dr
Clarksburg, WV 26301 - Phone
- (304) 623-3461
- NPI assigned
- May 22, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DP00941494 | WV | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | DP00941494 | WV | Yes |
Addresses
Primary practice location
1 Medical Center Dr
Clarksburg, WV 26301
Mailing address
205 High St
Jane Lew, WV 26378-7945
Phone (304) 629-6156
Other providers in Clarksburg, WV
- Debra Dawn Bennett
- Hollie Bennett
- Kimberly Ann Bennett
- Lauren Bennett
- N'Shay Bennett
- Brandi D Beresford
- Anna Besedich
- Patricia Beverly
- Amelia Biafora
- Melinda Renee Bibbee
All providers in Clarksburg, WV · Clinical Social Worker in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.