Provider Demographics
NPI:1356611586
Name:BENNETT, MARKISHA THERESSA
Entity type:Individual
Prefix:DR
First Name:MARKISHA
Middle Name:THERESSA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 TIMBERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2683
Mailing Address - Country:US
Mailing Address - Phone:954-681-0669
Mailing Address - Fax:
Practice Address - Street 1:308 TIMBERBROOK CT
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2683
Practice Address - Country:US
Practice Address - Phone:954-681-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist