Individual
DR. NICHOLAS KEITH BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1301 N BROADWAY STE 32424, LOS ANGELES, CA 90012-1408
(805) 225-4446
(805) 273-0206
Mailing address
1301 N BROADWAY STE 32424, LOS ANGELES, CA 90012-1408
(805) 225-4446
(805) 273-0206
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1336
WV
103T00000X
Psychologist
PSY.0006612
CO
103T00000X
Psychologist
PSY33288
CA
103TC0700X
Clinical Psychologist
PSY.0006612
CO
103TC0700X
Clinical Psychologist
PSY33288
CA
103TC1900X
Counseling Psychologist
PSY33288
CA
103TC1900X
Counseling Psychologist
—
WV
103TF0200X
Forensic Psychologist
Primary
PSY33288
CA
103TP2701X
Group Psychotherapy Psychologist
PSY33288
CA
Other
Enumeration date
03/15/2019
Last updated
04/14/2026
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