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General NPI Number Information
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NPI Number | 1992346944
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Entity Type | Individual
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Provider Name | AMANDA LORRAINE BENNETT MS, LMHC
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Gender | Female
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Dates
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Enumeration Date | 10/01/2019
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 2801 N FLAGLER DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-5215
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Country | US
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Telephone | 561-619-2158
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Fax |
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Provider Business Mailing Address
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Address Line | 10436 TRIANON PL
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City | WELLINGTON
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State | FL
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Zip | 33449-8074
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Country | US
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Telephone | 561-465-6798
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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 | MH16778
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License Number State | FL
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