Provider Demographics
NPI:1144099284
Name:BENNETT, PAIGE ROSE (MA, LMHC, LADAC, NCC)
Entity type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:ROSE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, LMHC, LADAC, NCC
Other - Prefix:MISS
Other - First Name:KERSTINE
Other - Middle Name:
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3807 35TH CIR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1805
Mailing Address - Country:US
Mailing Address - Phone:505-353-7926
Mailing Address - Fax:
Practice Address - Street 1:918 PINEHURST RD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2568
Practice Address - Country:US
Practice Address - Phone:505-218-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2025-0331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty