Provider Demographics
NPI:1861293771
Name:BENNETT, INA POLLY (BSW)
Entity type:Individual
Prefix:MS
First Name:INA
Middle Name:POLLY
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 WAXWING DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-5828
Mailing Address - Country:US
Mailing Address - Phone:850-501-2262
Mailing Address - Fax:
Practice Address - Street 1:1907 WAXWING DR
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-5828
Practice Address - Country:US
Practice Address - Phone:850-501-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator