Provider Demographics
NPI:1013774140
Name:BENNETT, SHENAY (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:
First Name:SHENAY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 GREENHAVEN DR APT 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3987
Mailing Address - Country:US
Mailing Address - Phone:707-718-3880
Mailing Address - Fax:
Practice Address - Street 1:525 21ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1605
Practice Address - Country:US
Practice Address - Phone:510-332-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-KLVHBD175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist