Provider Demographics
NPI:1467744003
Name:BENNETT, JOFFREE LYNETTE
Entity Type:Individual
Prefix:
First Name:JOFFREE
Middle Name:LYNETTE
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 1:2108 CLUB PACIFIC WAY APT 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0222
Mailing Address - Country:US
Mailing Address - Phone:702-272-7712
Mailing Address - Fax:702-438-4673
Practice Address - Street 1:2108 CLUB PACIFIC WAY APT 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0222
Practice Address - Country:US
Practice Address - Phone:702-272-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11147-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical