Healthcare Provider Details

I. General information

NPI: 1336444389
Provider Name (Legal Business Name): ADRIANE G BENNETT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6575 STRATHMORE DR
CLEVELAND OH
44125
US

IV. Provider business mailing address

PO BOX 660
MENTOR OH
44061-0660
US

V. Phone/Fax

Practice location:
  • Phone: 440-668-7772
  • Fax:
Mailing address:
  • Phone: 440-854-0217
  • Fax: 440-516-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.6761
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: