Provider Demographics
NPI:1912191602
Name:BENNETT, MARTA L (JD; MFT,)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:F
Credentials:JD; MFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25595 VIA CROTALO
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8404
Mailing Address - Country:US
Mailing Address - Phone:831-601-1109
Mailing Address - Fax:
Practice Address - Street 1:25595 VIA CROTALO
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8404
Practice Address - Country:US
Practice Address - Phone:831-601-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist