Provider Demographics
NPI:1154295335
Name:BENNETT, ANDREW KENNETH (RADT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:KENNETH
Last Name:BENNETT
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2952 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1515
Mailing Address - Country:US
Mailing Address - Phone:619-239-7370
Mailing Address - Fax:
Practice Address - Street 1:2952 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1515
Practice Address - Country:US
Practice Address - Phone:619-239-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CART1419840925101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty