Provider Demographics
NPI:1376291559
Name:BENNETT, LENISE (MPH, CIEM, CLC)
Entity Type:Individual
Prefix:MS
First Name:LENISE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MPH, CIEM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 EDGEWATER DRIVE
Mailing Address - Street 2:SUITE 2019
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:877-436-8527
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DRIVE
Practice Address - Street 2:SUITE 2019
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:877-436-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X, 374J00000X
FL1421130400029374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN