1568908234 NPI number — MARILYN BENNETT, LMHC

Table of content: (NPI 1568908234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568908234 NPI number — MARILYN BENNETT, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARILYN BENNETT, LMHC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568908234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 560875
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32956-0875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-631-5538
Provider Business Mailing Address Fax Number:
321-631-5154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4185 US HIGHWAY 1
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-5384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-631-5538
Provider Business Practice Location Address Fax Number:
321-631-5154
Provider Enumeration Date:
01/18/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
321-631-5538

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH7681 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD7681 . This is a "FLORIDA DEPARTMENT OF HEALTH - LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1295552736 . This is a "NATIONAL PROVIDER IDENTIFIER - INDIVIDUAL" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com