Individual
DR. ROBERT TODD BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1755 WESTGATE DR, SUITE 260, BOISE, ID 83704-7174
(208) 373-0790
(208) 373-0816
Mailing address
1755 WESTGATE DR, SUITE 260, BOISE, ID 83704-7174
(208) 373-0790
(208) 373-0816
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-411
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010031804
REGENCE BLUE SHIELD
ID
01
—
N5491
BLUE CROSS
ID
Enumeration date
10/10/2005
Last updated
05/03/2011
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