MEDICARE: CAITLYN MCKINZIE BENNETT PH.D., LMHC, LMFT, L

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	4120	FL
3	101YM0800X	Mental Health Counselor	15032	FL

General Provider Information

NPI Number	:	1649931791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN MCKINZIE BENNETT PH.D., LMHC, LMFT, L

Provider Business Mailing Address
First Line	:	3023 HARRISON AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-3731
Country	:	US
Telephone Number	:	850-625-1026
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 HARRISON AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-3731
Country	:	US
Telephone Number	:	850-625-1026
Fax Number	:

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

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	12/30/2021

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