Provider Demographics
NPI:1831308493
Name:BENNETT, DARREN L (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7649 HEWLETT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1429
Mailing Address - Country:US
Mailing Address - Phone:212-388-1903
Mailing Address - Fax:
Practice Address - Street 1:6634 79TH AVE
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2060
Practice Address - Country:US
Practice Address - Phone:727-504-6941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist