Provider Demographics
NPI:1518852300
Name:BENNETT, ITZEL MARIA
Entity type:Individual
Prefix:
First Name:ITZEL
Middle Name:MARIA
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 1:7055 BLANDING BLVD # 441051
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4422
Mailing Address - Country:US
Mailing Address - Phone:904-414-0261
Mailing Address - Fax:
Practice Address - Street 1:5560 GREATPINE LN N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5297
Practice Address - Country:US
Practice Address - Phone:904-414-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist