Individual
MRS. MAVIS BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
1100 S PONCE DE LEON BLVD STE 1, ST AUGUSTINE, FL 32084-6013
(904) 824-7733
(904) 829-9768
Mailing address
1100 S PONCE DE LEON BLVD STE 1, ST AUGUSTINE, FL 32084-6013
(904) 824-7733
(904) 829-9768
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
MT1268
FL
103TC1900X
Counseling Psychologist
MT1268
FL
Other
Enumeration date
10/24/2006
Last updated
09/11/2025
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