Provider Demographics
NPI:1891900098
Name:BENNETTE, HENRI EDWARD (PSYCHOLOGY/BEHAVIORA)
Entity Type:Individual
Prefix:MR
First Name:HENRI
Middle Name:EDWARD
Last Name:BENNETTE
Suffix:
Gender:M
Credentials:PSYCHOLOGY/BEHAVIORA
Other - Prefix:MR
Other - First Name:HENRY
Other - Middle Name:EDWARD
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGY
Mailing Address - Street 1:3933 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501
Mailing Address - Country:US
Mailing Address - Phone:951-328-2283
Mailing Address - Fax:651-684-6129
Practice Address - Street 1:PMB462 STE A 231 E. ALESSANDRO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-0000
Practice Address - Country:US
Practice Address - Phone:951-955-0842
Practice Address - Fax:951-955-8542
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN260-426-7234101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB21064OtherCLINICAL CRIMINAL JUSTICE DOMESTIC VIOLENCE COUSELOR MASTER ADDICTION COUSELOR
260-426-7234OtherNATIONAL ASSOCIATION OF FORENSIC COUNSELOR