Provider Demographics
NPI:1558064774
Name:BENNARD, REBECCA LORRAINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LORRAINE
Last Name:BENNARD
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 1:56 OAKLAND RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:RI
Mailing Address - Zip Code:02892-1746
Mailing Address - Country:US
Mailing Address - Phone:401-965-8984
Mailing Address - Fax:
Practice Address - Street 1:816 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1826
Practice Address - Country:US
Practice Address - Phone:401-356-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03535363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health