Provider Demographics
NPI:1407904014
Name:BENNETT-VACHON, BRENDA (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:BENNETT-VACHON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8136
Mailing Address - Country:US
Mailing Address - Phone:207-784-4301
Mailing Address - Fax:
Practice Address - Street 1:153 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8136
Practice Address - Country:US
Practice Address - Phone:207-784-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81162363LP0808X
MEAP081162363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME424300099Medicaid
MEQ29891Medicare UPIN
ME424300099Medicaid