Bennett, Jeffrey L

Bennett, Jeffrey L is an individual health care provider with primary practice located at 1600 Broad Ave , Gulfport MS 39501-3603. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Bennett, Jeffrey L can be contacted via phone (228) 863-1132.

Contact Information

Primary practice address
1600 Broad Ave Gulfport MS 39501-3603
Phone: (228) 863-1132
Fax: (228) 865-1700
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X C0580 Mississippi

Profile Details

NPI number 1740214089
LBN Legal business name Bennett, Jeffrey L
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Jul 8th, 2007 - about 19 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740214089 NPPES
Mississippi MEDICAID 00018213

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