Individual
STACY N BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRPA
Contact information
Practice address
304 E 165TH ST APT 4, BRONX, NY 10456-6073
(718) 790-5889
Mailing address
304 E 165TH ST APT 4, BRONX, NY 10456-6073
(718) 790-5889
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
5652
NY
Other
Enumeration date
04/27/2023
Last updated
04/27/2023
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