Provider Demographics
NPI:1861577967
Name:BENNETT, CATHERINE V (MFT)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:V
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:V
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:9655 GRANITE RIDGE DR STE 200-0027
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2674
Mailing Address - Country:US
Mailing Address - Phone:619-823-0204
Mailing Address - Fax:858-459-2128
Practice Address - Street 1:9655 GRANITE RIDGE DR STE 2000027
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2674
Practice Address - Country:US
Practice Address - Phone:619-823-0204
Practice Address - Fax:858-459-2128
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health