MEDICARE: DR. KATHLEEN ANN BENNETT PSY.D.

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	103TC0700X	Clinical Psychologist	0810004476	VA

General Provider Information

NPI Number	:	1497225791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN ANN BENNETT PSY.D.

Provider Business Mailing Address
First Line	:	1221 TREEFERN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6612
Country	:	US
Telephone Number	:	757-323-2786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 LANDSTOWN CENTRE WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1624
Country	:	US
Telephone Number	:	757-668-4673
Fax Number	:

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

Provider Enumeration Date	:	11/29/2018
Last Update Date	:	09/27/2024

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