Provider Demographics
NPI:1598046674
Name:BENNETT, JILLIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E CENTRAL ST STE 7-8
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3647
Mailing Address - Country:US
Mailing Address - Phone:781-591-7475
Mailing Address - Fax:508-655-5753
Practice Address - Street 1:99 E CENTRAL ST STE 7-8
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3647
Practice Address - Country:US
Practice Address - Phone:781-591-7475
Practice Address - Fax:508-655-5753
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist