Provider Demographics
NPI:1649931791
Name:BENNETT, CAITLYN MCKINZIE (PHD, LMHC, LMFT, L)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MCKINZIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD, LMHC, LMFT, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-3731
Mailing Address - Country:US
Mailing Address - Phone:850-625-1026
Mailing Address - Fax:
Practice Address - Street 1:3023 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3731
Practice Address - Country:US
Practice Address - Phone:850-625-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL4120106H00000X
FL15032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist