Provider Demographics
NPI:1982981759
Name:MATAMONASA BENNETT, ARIEAHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARIEAHN
Middle Name:
Last Name:MATAMONASA BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 S WASHINGTON ST STE 170
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6377
Mailing Address - Country:US
Mailing Address - Phone:630-305-6180
Mailing Address - Fax:
Practice Address - Street 1:2603 S WASHINGTON ST STE 170
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6377
Practice Address - Country:US
Practice Address - Phone:630-305-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical