Individual
DAVON BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
525 S 10TH ST, NEWARK, NJ 07103-1828
(862) 588-1277
Mailing address
525 S 10TH ST, NEWARK, NJ 07103-1828
(862) 588-1277
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
NJ
251S00000X
Community/Behavioral Health Agency
Primary
—
—
251X00000X
Supports Brokerage Agency
—
NJ
Other
Enumeration date
08/10/2015
Last updated
08/10/2015
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