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General NPI Number Information
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NPI Number | 1891900098
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Entity Type | Individual
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Provider Name | HENRI EDWARD BENNETTE PSYCHOLOGY/BEHAVIORA
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | PMB462 STE A 231 E. ALESSANDRO BLVD SUITE A
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City | RIVERSIDE
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State | CA
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Zip | 92508-0000
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Country | US
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Telephone | 951-955-0842
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Fax | 951-955-8542
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Provider Business Mailing Address
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Address Line | 3933 10TH ST
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City | RIVERSIDE
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State | CA
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Zip | 92501
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Country | US
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Telephone | 951-328-2283
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Fax | 651-684-6129
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 260-426-7234
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License Number State | IN
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