Provider Demographics
NPI:1376562785
Name:BENNETT, JANICE DRANDELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:DRANDELL
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 88TH ST APT 6B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1717
Mailing Address - Country:US
Mailing Address - Phone:212-874-1470
Mailing Address - Fax:212-787-3369
Practice Address - Street 1:255 W 88TH ST APT 6B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1717
Practice Address - Country:US
Practice Address - Phone:212-874-1470
Practice Address - Fax:866-411-9117
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10934103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01389871Medicaid
NY6801086OtherGHI, VALUEOPTIONS
NY6801086OtherGHI, VALUEOPTIONS