Provider Demographics
NPI:1194911883
Name:WILLIAM S BENNETT PHD PC
Entity type:Organization
Organization Name:WILLIAM S BENNETT PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-343-1474
Mailing Address - Street 1:2311 CANTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:910-343-1474
Mailing Address - Fax:
Practice Address - Street 1:2311 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-343-1474
Practice Address - Fax:910-763-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000525Medicaid
NC0328UOtherBLUE CROSS BLUE SHIELD NC
NC61-100549OtherUNITED BEHAVIORAL HEALTH
NC1051812OtherCIGNA/MCC
NC75117OtherMEDCOST
NC2816302BMedicare PIN
2820583Medicare PIN