Individual
LEEANN ROSE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 HAVEN ST, PORT MONMOUTH, NJ 07758-1407
(732) 939-1589
Mailing address
1 HAVEN ST, PORT MONMOUTH, NJ 07758-1407
(732) 939-1589
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/04/2020
Last updated
05/04/2020
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