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General NPI Number Information
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NPI Number | 1831002377
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Entity Type | Individual
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Provider Name | ANGEL LEE BENNETT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 540 NW UNIVERSITY BLVD STE 204
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2281
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Country | US
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Telephone | 772-494-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 386 NW STRATFORD LN
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-3432
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 29836
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License Number State | FL
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