Provider Demographics
NPI:1083397855
Name:BENNETT, AMBER (CT)
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 N FREEDOM ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2470
Mailing Address - Country:US
Mailing Address - Phone:330-295-5552
Mailing Address - Fax:
Practice Address - Street 1:1414 S GREEN RD STE 307
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3976
Practice Address - Country:US
Practice Address - Phone:216-340-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC2506933TRNE101Y00000X
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor