Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 24574 | TX |
N | 103T00000X | Psychologist | 24574 | TX |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 24574 | TX |
N | 103G00000X | Clinical Psychologist | 24574 | TX |
N | 103TC0700X | Clinical Psychologist | 24574 | TX |
N | 103TP2701X | Group Psychotherapist | 24574 | TX |
NPI | 1285642405 |
---|---|
Provider Name | Dr. Janice A. Bennett |
First Address | Ft Worth, TX 76107-4607 |
Second Address | Ft Worth, TX 76107-4607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |