Provider Demographics
NPI:1619620424
Name:BENNETT, KERRY (LCPC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FAIRFIELD HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046-5222
Mailing Address - Country:US
Mailing Address - Phone:206-930-6435
Mailing Address - Fax:
Practice Address - Street 1:20 FAIRFIELD HILL RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNKPORT
Practice Address - State:ME
Practice Address - Zip Code:04046-5222
Practice Address - Country:US
Practice Address - Phone:206-930-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional