Provider Demographics
NPI:1851199319
Name:BENNETT, COLE REILLY
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:REILLY
Last Name:BENNETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ASPIRE DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-0989
Mailing Address - Country:US
Mailing Address - Phone:856-506-2949
Mailing Address - Fax:
Practice Address - Street 1:7775 BAYMEADOWS WAY SUITE 200, JACKSONVILLE, FL 32256
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092
Practice Address - Country:US
Practice Address - Phone:760-710-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician