Healthcare Provider Details

I. General information

NPI: 1770194029
Provider Name (Legal Business Name): STEPHEN DOUGLAS BENNETT MA, LPC, BC-L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 FAIRMONT DR
CHESTER SPRINGS PA
19425-3685
US

IV. Provider business mailing address

304 BIRMINGHAM WAY
EXTON PA
19341-2745
US

V. Phone/Fax

Practice location:
  • Phone: 610-505-6159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCO16746
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH004783
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: