Provider Demographics
NPI:1861638090
Name:BENNETT, PAULA JOYCE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:JOYCE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5762 BOLSA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1172
Mailing Address - Country:US
Mailing Address - Phone:714-898-0362
Mailing Address - Fax:714-893-3267
Practice Address - Street 1:5762 BOLSA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1172
Practice Address - Country:US
Practice Address - Phone:714-898-0362
Practice Address - Fax:714-893-3267
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22301103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist