Individual
GENETTA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32 LOOMIS ST, CAMBRIDGE, MA 02138-1003
(914) 362-9697
Mailing address
32 LOOMIS ST, CAMBRIDGE, MA 02138-1003
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MA
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
01
—
NS
NA
—
Enumeration date
07/08/2021
Last updated
07/08/2021
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