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General NPI Number Information
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NPI Number | 1487900536
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Entity Type | Organization
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Legal Business Name | TRICIA BENNETT
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 148 OTIS RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-6258
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Country | US
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Telephone | 631-286-2797
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Fax |
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Provider Business Mailing Address
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Address Line | 148 OTIS RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-6258
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Country | US
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Telephone | 631-286-2797
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATION REACHER
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Name | TRICIA LYNN BENNETT
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Credential | MS.ED
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Telephone | 631-514-5963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | NY
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