Provider Demographics
NPI:1467161448
Name:BENNETT, LATONYA MARIE
Entity Type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 DUNHAM RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4407
Mailing Address - Country:US
Mailing Address - Phone:216-299-4564
Mailing Address - Fax:
Practice Address - Street 1:6051 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4407
Practice Address - Country:US
Practice Address - Phone:216-299-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No372600000XNursing Service Related ProvidersAdult Companion
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child