Healthcare Provider Details

I. General information

NPI: 1780518290
Provider Name (Legal Business Name): MYKALEE BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 GREENWAY CENTER DR STE 1300
GREENBELT MD
20770-3575
US

IV. Provider business mailing address

3723 OAK AVE
BALTIMORE MD
21207-6338
US

V. Phone/Fax

Practice location:
  • Phone: 443-635-4337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: