Individual
KELLY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
910 SYCAMORE AVE STE 270, VISTA, CA 92081-7852
(760) 697-3100
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
Taxonomy
Speciality
Code
Description
License number
State
103TH0004X
Health Psychologist
Primary
32917
CA
Other
Enumeration date
06/20/2018
Last updated
01/21/2022
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