Healthcare Provider Details

I. General information

NPI: 1154094712
Provider Name (Legal Business Name): CHARLOTTE E BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD STE E340
STUART FL
34994-2471
US

IV. Provider business mailing address

614 30TH AVE SW
VERO BEACH FL
32968-3223
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-3439
  • Fax:
Mailing address:
  • Phone: 772-643-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: