MEDICARE: MS. JILL ELAINE BENNETT LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	001340-1	NY

General Provider Information

NPI Number	:	1679519995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL ELAINE BENNETT LMHC

Provider Business Mailing Address
First Line	:	14 GOULD PL
Second Line	:
City	:	WALLKILL
State	:	NY
Zip	:	12589-2733
Country	:	US
Telephone Number	:	845-234-0872
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 GOULD PL
Second Line	:
City	:	WALLKILL
State	:	NY
Zip	:	12589-2733
Country	:	US
Telephone Number	:	845-234-0872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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