Bennett, Bert
Bennett, Bert is an sole proprietor health care provider with primary practice located at 3111 Maplewood Ave Suite 105, Winston-Salem NC 27103-3906. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counseling, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Bennett, Bert can be contacted via phone (336) 624-6412.Contact Information
Primary practice address
3111 Maplewood Ave Suite 105
Winston-Salem NC 27103-3906
Phone: (336) 624-6412
Fax: (336) 724-3839
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Counseling | 103TC1900X | 1361 | North Carolina |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 1361 | North Carolina |
Profile Details
| NPI number | 1750323705 |
|---|---|
| LBN Legal business name | Bennett, Bert |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 12th, 2006 |
| Last updated | Jun 7th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750323705 | NPPES |
| North Carolina | MEDICAID | 6000742 |
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