Basic Information
| Provider Information | |||||||||
| NPI: | 1447284534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 OLD ELMDALE RD | ||||||||
| Address2: | |||||||||
| City: | UXBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015691348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012357000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 181 CUMBERLAND ST | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028953301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012357000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 11/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW00567 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0000030452 | 01 | RI | BLUE CROSS | OTHER | 1021720 | 01 | RI | UNITED HEALTH | OTHER | 406746 | 01 | RI | BLUE CHIP | OTHER | BB03403 | 05 | RI | MEDICAID |