Provider Demographics
NPI:1396752895
Name:BENNETT, BEVERLY C (LMFT)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 GRANT PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5600
Mailing Address - Country:US
Mailing Address - Phone:321-728-9949
Mailing Address - Fax:270-568-7607
Practice Address - Street 1:2015 GRANT PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5600
Practice Address - Country:US
Practice Address - Phone:321-728-9949
Practice Address - Fax:270-568-7607
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0001101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist