Provider Demographics
NPI:1073690475
Name:BENNETT, GEORGE EDWARD JR (MA, MAMS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
Last Name:BENNETT
Suffix:JR
Gender:M
Credentials:MA, MAMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 HERRS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8451
Mailing Address - Country:US
Mailing Address - Phone:717-337-2695
Mailing Address - Fax:
Practice Address - Street 1:129 CHARLES ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1807
Practice Address - Country:US
Practice Address - Phone:717-633-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI016190101YM0800X
PAPC004454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health