Provider Demographics
NPI:1548499916
Name:BENNETT-SPEIGHT, CAROL ANN (SOCIAL WORK)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:BENNETT-SPEIGHT
Suffix:
Gender:F
Credentials:SOCIAL WORK
Other - Prefix:DR
Other - First Name:CARP;
Other - Middle Name:ANN
Other - Last Name:SPEIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOCIAL WORK
Mailing Address - Street 1:8220 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2729
Mailing Address - Country:US
Mailing Address - Phone:215-728-4609
Mailing Address - Fax:267-350-4887
Practice Address - Street 1:8220 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2729
Practice Address - Country:US
Practice Address - Phone:215-728-4609
Practice Address - Fax:267-350-4887
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW003629E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical