Provider Demographics
NPI:1336268325
Name:BENNETT, ARIENE NICOLE (MFT)
Entity Type:Individual
Prefix:MS
First Name:ARIENE
Middle Name:NICOLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 COMMERCENTER W
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3333
Mailing Address - Country:US
Mailing Address - Phone:909-386-0335
Mailing Address - Fax:
Practice Address - Street 1:1802 COMMERCENTER W
Practice Address - Street 2:SUITE B
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3333
Practice Address - Country:US
Practice Address - Phone:909-386-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist