Individual
MARILYN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1 OLEANDER ST STE 3, COCOA, FL 32922-7900
(321) 631-5538
(321) 631-5154
Mailing address
2593 S PARK AVE, TITUSVILLE, FL 32780-5147
(321) 631-5538
(321) 631-5154
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
FL
101YP2500X
Professional Counselor
Primary
MH 7681
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0764698 00
—
FL
Enumeration date
01/05/2007
Last updated
09/18/2018
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