MEDICARE: DARIN BENNETT M.A.

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	106H00000X	Marriage & Family Therapist	MFC47879	CA

General Provider Information

NPI Number	:	1609915545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIN BENNETT M.A.

Provider Business Mailing Address
First Line	:	5350 WALDO PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1670
Country	:	US
Telephone Number	:	323-240-7954
Fax Number	:

Provider Business Practice Location Address
First Line	:	8616 LA TIJERA BLVD
Second Line	:	#404
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3944
Country	:	US
Telephone Number	:	310-982-6062
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	04/12/2017

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