Provider Demographics
NPI:1053851493
Name:BENNETT, ELIZABETH A (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4040 LAKE FOREST LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3380
Mailing Address - Country:US
Mailing Address - Phone:269-303-2302
Mailing Address - Fax:269-488-5906
Practice Address - Street 1:821 W SOUTH ST STE C
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4664
Practice Address - Country:US
Practice Address - Phone:269-303-2302
Practice Address - Fax:269-488-5906
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-05
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010938311041C0700X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical