MEDICARE: ROBERT BENNETT B.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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1760600761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BENNETT B.A.

Provider Business Mailing Address
First Line	:	2990 S MADISON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-6554
Country	:	US
Telephone Number	:	303-953-3227
Fax Number	:

Provider Business Practice Location Address
First Line	:	5909 SOUTH SANTA FE DRIVE
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-2910
Country	:	US
Telephone Number	:	303-953-3227
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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