Provider Demographics
NPI:1922353283
Name:BENNETTE, JOHN WILBERT JR (MSM)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILBERT
Last Name:BENNETTE
Suffix:JR
Gender:M
Credentials:MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 W CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1808
Mailing Address - Country:US
Mailing Address - Phone:407-836-8800
Mailing Address - Fax:407-836-8853
Practice Address - Street 1:823 W CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1808
Practice Address - Country:US
Practice Address - Phone:404-836-8800
Practice Address - Fax:407-836-8853
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor