Provider Demographics
NPI:1215182159
Name:BENNETT, BARBARA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BEDFORD AVE
Mailing Address - Street 2:ROOM #4400 BOYLAN HALL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2850
Mailing Address - Country:US
Mailing Address - Phone:718-951-5186
Mailing Address - Fax:718-951-4363
Practice Address - Street 1:2900 BEDFORD AVE
Practice Address - Street 2:ROOM #4400 BOYLAN HALL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2850
Practice Address - Country:US
Practice Address - Phone:718-951-5186
Practice Address - Fax:718-951-4363
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002904-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist