Provider Demographics
NPI:1326396466
Name:BENNETT, STEPHEN NOEL (MS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NOEL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 HOONANEA ST
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8041
Mailing Address - Country:US
Mailing Address - Phone:323-447-3375
Mailing Address - Fax:
Practice Address - Street 1:1772 HOONANEA ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8041
Practice Address - Country:US
Practice Address - Phone:323-447-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor