Provider Demographics
NPI:1891057972
Name:BENNETT, JENNIFER (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 SEDGWICK AVE APT 6D
Mailing Address - Street 2:6D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-2033
Mailing Address - Country:US
Mailing Address - Phone:917-693-9134
Mailing Address - Fax:
Practice Address - Street 1:2510 WESTCHESTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3512
Practice Address - Country:US
Practice Address - Phone:718-597-5558
Practice Address - Fax:718-597-7277
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst