Provider Demographics
NPI:1578758223
Name:BENNETT, SUSAN ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSIE
Other - Middle Name:E
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:417 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3736
Mailing Address - Country:US
Mailing Address - Phone:413-419-9103
Mailing Address - Fax:
Practice Address - Street 1:417 LIBERTY ST
Practice Address - Street 2:ENTRANCE D
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3736
Practice Address - Country:US
Practice Address - Phone:413-419-9103
Practice Address - Fax:413-731-8651
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health