Provider Demographics
NPI:1093906497
Name:BENNETT-PENDINO, VIJA (PH D)
Entity Type:Individual
Prefix:
First Name:VIJA
Middle Name:
Last Name:BENNETT-PENDINO
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 MELVIN AVE S
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7030
Mailing Address - Country:US
Mailing Address - Phone:215-378-0551
Mailing Address - Fax:
Practice Address - Street 1:237 MELVIN AVE S
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-7030
Practice Address - Country:US
Practice Address - Phone:215-378-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005351L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABE719027OtherBLUE CROSS /BLUE SHIELD
PA0556032000OtherBLUE SHIELD, VENDOR
PA0556032000OtherBLUE SHIELD, VENDOR