Provider Demographics
NPI:1689713802
Name:BENNETT, JANICE O (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:O
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 1:260 W 72ND ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2817
Mailing Address - Country:US
Mailing Address - Phone:212-787-5110
Mailing Address - Fax:212-854-9473
Practice Address - Street 1:260 W 72ND ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2817
Practice Address - Country:US
Practice Address - Phone:212-787-5110
Practice Address - Fax:212-854-9473
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010327103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist