Provider Demographics
NPI:1568908234
Name:MARILYN BENNETT, LMHC
Entity Type:Organization
Organization Name:MARILYN BENNETT, LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-631-5538
Mailing Address - Street 1:PO BOX 560875
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-0875
Mailing Address - Country:US
Mailing Address - Phone:321-631-5538
Mailing Address - Fax:321-631-5154
Practice Address - Street 1:4185 US HIGHWAY 1
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5384
Practice Address - Country:US
Practice Address - Phone:321-631-5538
Practice Address - Fax:321-631-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7681OtherFLORIDA DEPARTMENT OF HEALTH - LICENSE
1295552736OtherNATIONAL PROVIDER IDENTIFIER - INDIVIDUAL