Provider Demographics
NPI:1427073477
Name:BENNETT, TIMOTHY FRANCIS (MA LPC/CAC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:FRANCIS
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MA LPC/CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 FISHBURN RD
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2015
Mailing Address - Country:US
Mailing Address - Phone:717-533-7404
Mailing Address - Fax:717-520-1295
Practice Address - Street 1:825 FISHBURN RD
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2015
Practice Address - Country:US
Practice Address - Phone:717-533-7404
Practice Address - Fax:717-520-1295
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA227064101YA0400X
PAPC001611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA257595OtherVALUE OPTIONS
PA50000176OtherCAPITAL BLUE CROSS