Provider Demographics
NPI:1811531361
Name:BENNETT, DEBRA (PMHNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42335 WASHINGTON ST STE 151
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-8004
Mailing Address - Country:US
Mailing Address - Phone:310-403-7681
Mailing Address - Fax:
Practice Address - Street 1:73315 HAYSTACK RD
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-6058
Practice Address - Country:US
Practice Address - Phone:310-403-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013936363LP0808X
CA644128363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health