Individual
TANISHA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 H ST NW STE 640, WASHINGTON, DC 20005-5538
(202) 846-8043
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
724975312
AMERIGROUP
DC
Enumeration date
12/03/2019
Last updated
12/03/2019
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