| Doctor Name: | MS. DEBRA LANOUE BENNETT |
| NPI Number: | 1104190917 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW-R |
| License Number: | R052072-1 |
| Business Practice Address: | 1 Mcguffey Ln Delmar, NY - 120544133 |
| Business Phone Number: | 5184394905 |
| Business Fax Number: | |
| Mailing Address: | 105 Diane Ln, TROY |
| State: | NY |
| Postal Code: | 121829713 |
| Phone Number: | 5183262753 |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2012 |
| NPI Last Update Date: | 02/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | R052072-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |