Provider Demographics
NPI:1356485635
Name:BENNETT, BRENDA E (LMFT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 E VISTA WAY
Mailing Address - Street 2:PMB 219
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4606
Mailing Address - Country:US
Mailing Address - Phone:707-972-3546
Mailing Address - Fax:
Practice Address - Street 1:4141 PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2030
Practice Address - Country:US
Practice Address - Phone:619-497-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004877101YM0800X
CAMFC 45218106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health