Healthcare Provider Details

I. General information

NPI: 1861638090
Provider Name (Legal Business Name): PAULA JOYCE BENNETT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5762 BOLSA AVE SUITE 107
HUNTINGTON BEACH CA
92649-1172
US

IV. Provider business mailing address

5762 BOLSA AVE SUITE 107
HUNTINGTON BEACH CA
92649-1172
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-0362
  • Fax: 714-893-3267
Mailing address:
  • Phone: 714-898-0362
  • Fax: 714-893-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 22301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: