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General NPI Number Information
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NPI Number | 1174048748
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Entity Type | Individual
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Provider Name | STEVEN BENNETT
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Gender | Male
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 75 HOLLY HILL LN
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City | GREENWICH
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State | CT
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Zip | 06830-6098
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Country | US
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Telephone | 203-489-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 199 LARCHMONT AVE
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City | LARCHMONT
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State | NY
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Zip | 10538-2816
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Country | US
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Telephone | 608-228-8247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 003122
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License Number State |
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