Provider Demographics
NPI:1710489091
Name:BENNETT ASSESSMENT AND BEHAVIOR CENTER FOR CHILDREN, LLC
Entity Type:Organization
Organization Name:BENNETT ASSESSMENT AND BEHAVIOR CENTER FOR CHILDREN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST/BCBA
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D, LABA
Authorized Official - Phone:781-591-7475
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA489103K00000X
MA9400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty