Provider Demographics
NPI:1336829506
Name:HEITT, BENNETT MCMASTER (MA, MS)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:MCMASTER
Last Name:HEITT
Suffix:
Gender:M
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RESERVOIR CIR STE 105
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6362
Mailing Address - Country:US
Mailing Address - Phone:443-996-0088
Mailing Address - Fax:
Practice Address - Street 1:8 RESERVOIR CIR STE 105
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6362
Practice Address - Country:US
Practice Address - Phone:443-996-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0793101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor