Healthcare Provider Details

I. General information

NPI: 1083592687
Provider Name (Legal Business Name): REY E BENNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ELIO BENNETT

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 PROSPECT ST
HARTFORD CT
06103-2814
US

IV. Provider business mailing address

700 BLOOMFIELD AVE
BLOOMFIELD CT
06002-2497
US

V. Phone/Fax

Practice location:
  • Phone: 860-997-9450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: