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General NPI Number Information
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NPI Number | 1629104765
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Entity Type | Individual
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Provider Name | RODERICK MACLEAN BENNETT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 61 CLAREMONT RD
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2200
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Country | US
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Telephone | 908-766-1221
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Fax | 908-766-9577
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-0007
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Country | US
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Telephone | 908-766-1221
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Fax | 908-766-9577
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00170200
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License Number State | NJ
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