Provider Demographics
NPI:1093971731
Name:HOLBROOK, BENNETT HILTON (LCPC-C)
Entity Type:Individual
Prefix:MR
First Name:BENNETT
Middle Name:HILTON
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WOODWARD POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3822
Mailing Address - Country:US
Mailing Address - Phone:207-522-2369
Mailing Address - Fax:
Practice Address - Street 1:62 WOODWARD POINT RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3822
Practice Address - Country:US
Practice Address - Phone:207-522-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health