Provider Demographics
NPI:1730504242
Name:BENNETT, RITA PERRY (PHD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:PERRY
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HIGHLAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2634
Mailing Address - Country:US
Mailing Address - Phone:856-854-3155
Mailing Address - Fax:856-854-0992
Practice Address - Street 1:215 HIGHLAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2634
Practice Address - Country:US
Practice Address - Phone:856-854-3155
Practice Address - Fax:856-854-0992
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100517800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist