Provider Demographics
NPI:1932499068
Name:BENNETT, LORRIE ANN (MASTERS OF ED)
Entity Type:Individual
Prefix:MS
First Name:LORRIE
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MASTERS OF ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 BURLINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7428
Mailing Address - Country:US
Mailing Address - Phone:727-343-0848
Mailing Address - Fax:
Practice Address - Street 1:7301 BURLINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7428
Practice Address - Country:US
Practice Address - Phone:727-343-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency