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NPI Code Detail

MEDICARE: BRENDA E BENNETT LMFT

MEDICARE: BRENDA E BENNETT LMFT
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
1101YM0800XMental Health Counselor180004877IL
2106H00000XMarriage & Family TherapistMFC 45218CA

General Provider Information

NPI Number : 1356485635
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA E BENNETT LMFT
Provider Business Mailing Address
First Line : 1035 E VISTA WAY
Second Line : PMB 219
City : VISTA
State : CA
Zip : 92084-4606
Country : US
Telephone Number : 707-972-3546
Fax Number :
Provider Business Practice Location Address
First Line : 4141 PACIFIC HWY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2030
Country : US
Telephone Number : 619-497-0142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 05/12/2008

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