Organization
J BENNETT GROUP PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANNE M BENNETT PSYD (PRES/CEO)
(502) 376-7552
Entity
Organization
Contact information
Practice address
1169 EASTERN PKWY STE 2238, LOUISVILLE, KY 40217-1444
(502) 376-7552
(502) 425-5540
Mailing address
1603 STEVENS AVE, SUITE 202, LOUISVILLE, KY 40205-1087
(502) 376-7552
(502) 425-5540
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1034
KY
103G00000X
Clinical Neuropsychologist
Primary
129055
KY
103TC0700X
Clinical Psychologist
1034
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000376780
ANTHEM
KY
01
—
50107908
PASSPORT HEALTH
KY
01
—
7944828
AETNA
KY
05
—
89900344
—
KY
Enumeration date
03/11/2008
Last updated
07/21/2022
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