Provider Demographics
NPI:1700181757
Name:BENNETT, ELIZABETH MORGAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MORGAN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1936 WINTERPORT CLUSTER
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3652
Mailing Address - Country:US
Mailing Address - Phone:703-973-3863
Mailing Address - Fax:
Practice Address - Street 1:1984 ISAAC NEWTON SQ W
Practice Address - Street 2:SUITE 204
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5038
Practice Address - Country:US
Practice Address - Phone:703-973-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical