Provider Demographics
NPI:1114593126
Name:BENNETT, CINDY AILEEN (LMHC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:AILEEN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:AILEEN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:199 DALI BLVD UNIT 1003
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3991
Mailing Address - Country:US
Mailing Address - Phone:727-599-8260
Mailing Address - Fax:
Practice Address - Street 1:199 DALI BLVD UNIT 1003
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3991
Practice Address - Country:US
Practice Address - Phone:727-599-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health