Provider Demographics
NPI:1679519995
Name:BENNETT, JILL ELAINE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELAINE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GOULD PL
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-2733
Mailing Address - Country:US
Mailing Address - Phone:845-234-0872
Mailing Address - Fax:
Practice Address - Street 1:14 GOULD PL
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-2733
Practice Address - Country:US
Practice Address - Phone:845-234-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001340-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health