Provider Demographics
NPI:1942604962
Name:BENNETT, CHRISTINE ANDREOTTI (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANDREOTTI
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1145
Mailing Address - Country:US
Mailing Address - Phone:516-695-7299
Mailing Address - Fax:
Practice Address - Street 1:38 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:PORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07758-1145
Practice Address - Country:US
Practice Address - Phone:516-695-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00212600101YM0800X
NJ37PC00659100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health