Provider Demographics
NPI:1427415322
Name:BENNETT, RICHARD JR (CASAC T)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BENNETT
Suffix:JR
Gender:M
Credentials:CASAC T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2629
Mailing Address - Country:US
Mailing Address - Phone:718-827-8700
Mailing Address - Fax:718-827-0550
Practice Address - Street 1:2640 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2629
Practice Address - Country:US
Practice Address - Phone:718-827-8700
Practice Address - Fax:718-827-0550
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)