Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY60482081 | WA |
Y | 103TC0700X | Clinical Psychologist | PY60482081 | WA |
NPI | 1003954330 |
---|---|
Provider Name | Dr. Matthew James Bennett |
First Address | Issaquah, WA 98027-5488 |
Second Address | Bellevue, WA 98004-6901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 16/03/2015 |