Provider Demographics
NPI:1891076782
Name:BENNETT, SUSAN RAYE (LPCMH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RAYE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MIDDLEFORD RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3670
Mailing Address - Country:US
Mailing Address - Phone:302-236-2394
Mailing Address - Fax:302-536-7498
Practice Address - Street 1:1310 MIDDLEFORD RD
Practice Address - Street 2:STE 102
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3670
Practice Address - Country:US
Practice Address - Phone:302-404-3399
Practice Address - Fax:302-536-7498
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
DE0000565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000593172Medicaid