Healthcare Provider Details

I. General information

NPI: 1518882281
Provider Name (Legal Business Name): BENNETT PSYCHOLOGICAL SOLUTIONS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 NE 191ST ST STE 13582
MIAMI FL
33179-3899
US

IV. Provider business mailing address

390 NE 191ST ST STE 13582
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 805-225-4446
  • Fax: 805-273-0206
Mailing address:
  • Phone: 805-225-4446
  • Fax: 805-273-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS KEITH BENNETT
Title or Position: OWNER
Credential: PSYD
Phone: 805-793-5669