Provider Demographics
NPI:1174730139
Name:BENNETT, BEVERLEY (BA)
Entity type:Individual
Prefix:MS
First Name:BEVERLEY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 JONES ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5414
Mailing Address - Country:US
Mailing Address - Phone:707-463-0405
Mailing Address - Fax:707-463-0405
Practice Address - Street 1:410 JONES ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6340
Practice Address - Country:US
Practice Address - Phone:707-463-0406
Practice Address - Fax:707-463-0405
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator