Provider Demographics
NPI:1861647265
Name:BENNETT, PATRICIA NEWELL (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:NEWELL
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0944
Mailing Address - Country:US
Mailing Address - Phone:508-645-5099
Mailing Address - Fax:
Practice Address - Street 1:5 DILLEY WAY
Practice Address - Street 2:BOX 314
Practice Address - City:CHIMARK
Practice Address - State:MA
Practice Address - Zip Code:02535-0944
Practice Address - Country:US
Practice Address - Phone:508-645-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health