Provider Demographics
NPI:1871896290
Name:BENNER, DEANNA GAIL (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:GAIL
Last Name:BENNER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 ROUTE 38 STE C
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2923
Mailing Address - Country:US
Mailing Address - Phone:609-203-4503
Mailing Address - Fax:609-702-5882
Practice Address - Street 1:1632 ROUTE 38 STE C
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2923
Practice Address - Country:US
Practice Address - Phone:609-203-4503
Practice Address - Fax:609-702-5882
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053040001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical