Provider Demographics
NPI:1891023123
Name:BENNETT, TODD A (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 CONCORD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1238
Mailing Address - Country:US
Mailing Address - Phone:603-723-2049
Mailing Address - Fax:
Practice Address - Street 1:174 CONCORD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1238
Practice Address - Country:US
Practice Address - Phone:603-723-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004693101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health