MEDICARE: ERICA PAULINE BENNETT

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	LAC-23163	AZ

General Provider Information

NPI Number	:	1811843113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA PAULINE BENNETT

Provider Business Mailing Address
First Line	:	12530 W LINCOLN ST
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-8453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25932 N SANDSTONE WAY
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85387-6837
Country	:	US
Telephone Number	:	602-638-2424
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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