Provider Demographics
NPI:1134662224
Name:BENNETT, CINDY
Entity Type:Individual
Prefix:MISS
First Name:CINDY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2422
Mailing Address - Country:US
Mailing Address - Phone:781-985-7939
Mailing Address - Fax:617-328-0409
Practice Address - Street 1:43 OLD COLONY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-2606
Practice Address - Country:US
Practice Address - Phone:617-328-1734
Practice Address - Fax:617-328-0409
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)