MEDICARE: MRS. TERESA RENEE BENNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		SC

General Provider Information

NPI Number	:	1255262820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA RENEE BENNETT

Provider Business Mailing Address
First Line	:	154 BELFAST WAY
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-9806
Country	:	US
Telephone Number	:	717-421-5449
Fax Number	:	839-205-1889

Provider Business Practice Location Address
First Line	:	154 BELFAST WAY
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-9806
Country	:	US
Telephone Number	:	717-421-5449
Fax Number	:	839-205-1889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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