MEDICARE: DR. BERT BENNETT III PH.D.

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	103TC1900X	Counseling Psychologist	1361	NC
2	103T00000X	Psychologist	1361	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750323705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERT BENNETT III PH.D.

Provider Business Mailing Address
First Line	:	1684 CHICKASHA DR
Second Line	:
City	:	PFAFFTOWN
State	:	NC
Zip	:	27040-8210
Country	:	US
Telephone Number	:	336-638-1812
Fax Number	:	336-946-1075

Provider Business Practice Location Address
First Line	:	3111 MAPLEWOOD AVE
Second Line	:	SUITE 105
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-3906
Country	:	US
Telephone Number	:	336-624-6412
Fax Number	:	336-724-3839

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	06/07/2021

Similar Medicare Providers

1508857228 — HEARING CARE CENTER
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 107
WINSTON SALEM, NC
27103-3906

Practice Phone: 336-659-9569
Practice Fax: 336-768-8379

1801851506 — DR. BEVERLY NICHOLAS JONES MD
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 105
WINSTON SALEM, NC
27103-3906

Practice Phone: 336-659-8817
Practice Fax: 336-659-7799

1356383251 — MS. ELIZABETH BENNETT TOWNSEND M.S.
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 105
WINSTON-SALEM, NC
27103-3906

Practice Phone: 336-659-8817
Practice Fax: 336-659-7799

1184719841 — NANCY B LONG LCSW
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 105
WINSTON SALEM, NC
27103-3906

Practice Phone: 336-659-8817
Practice Fax:

1972652469 — BEVERLY N JONES III MD PA
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 105
WINSTON SALEM, NC
27103-3906

Practice Phone: 336-659-8817
Practice Fax: 336-659-7799

1285774166 — DR. J GRADY ELLIOTT O.D.
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 103
WINSTON SALEM, NC
27103-3906

Practice Phone: 336-765-8130
Practice Fax: 336-765-6403

Directions to “ DR. BERT BENNETT III PH.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.