Provider Demographics
NPI:1003466186
Name:MARISSA BENNETT CONSULTING, LLC
Entity Type:Organization
Organization Name:MARISSA BENNETT CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, BCBA
Authorized Official - Phone:847-651-9907
Mailing Address - Street 1:666 DUNDEE RD STE 1605
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2738
Mailing Address - Country:US
Mailing Address - Phone:847-495-2640
Mailing Address - Fax:847-324-2184
Practice Address - Street 1:666 DUNDEE RD STE 1605
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2738
Practice Address - Country:US
Practice Address - Phone:847-495-2640
Practice Address - Fax:847-324-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty