Provider Demographics
NPI:1417914995
Name:BENNETT, JOHN LLOYD II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LLOYD
Last Name:BENNETT
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13357 VIA VESTA APT A
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3105
Mailing Address - Country:US
Mailing Address - Phone:646-299-5301
Mailing Address - Fax:
Practice Address - Street 1:13357 VIA VESTA APT A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3105
Practice Address - Country:US
Practice Address - Phone:646-299-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW183821041C0700X
CALCSW1129971041C0700X
NY73-0713021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7V921Medicare ID - Type Unspecified