Individual
BRENDA S BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2011 S 25TH ST STE 108, FORT PIERCE, FL 34947-4795
(772) 242-1079
(772) 242-1296
Mailing address
2011 S 25TH ST STE 108, FORT PIERCE, FL 34947-4795
(772) 242-1079
(772) 242-1296
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103T00000X
103T00000X
—
Enumeration date
12/02/2020
Last updated
12/02/2020
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