Provider Demographics
NPI:1184802241
Name:BENNETT, CHERYL LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 KILDAIRE FARM RD # 1012
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5525
Mailing Address - Country:US
Mailing Address - Phone:980-224-3677
Mailing Address - Fax:
Practice Address - Street 1:2609 N DUKE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3048
Practice Address - Country:US
Practice Address - Phone:980-224-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3881251S00000X, 103TC0700X, 103T00000X, 103T00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No251S00000XAgenciesCommunity/Behavioral Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
20456OtherCBHA
NC531923OtherTRICARE
531923OtherTRICARE
56162OtherMEDCOST
1543ROtherBCBS
531923OtherMHN
NC56162OtherMEDCOST
NPIOtherUNITED HEALTHCARE/ UNITED BEHAVIORAL HEALTH
NC6107588Medicaid
NC1543ROtherBLUE CROSS BLUE SHIELD
NC9440507OtherAETNA