Provider Demographics
NPI:1538940762
Name:BENNETT, LILY GRACE (LMSW)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:GRACE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 TIEMANN PL APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3333
Mailing Address - Country:US
Mailing Address - Phone:312-989-8696
Mailing Address - Fax:
Practice Address - Street 1:55 TIEMANN PL APT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3333
Practice Address - Country:US
Practice Address - Phone:312-989-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker