Doctor Name: | DR. RODERICK MACLEAN BENNETT |
NPI Number: | 1629104765 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 35SI00170200 |
Business Practice Address: | 61 Claremont Rd Bernardsville, NJ - 079242200 |
Business Phone Number: | 9087661221 |
Business Fax Number: | 9087669577 |
Mailing Address: | Po Box 7, BASKING RIDGE |
State: | NJ |
Postal Code: | 079200007 |
Phone Number: | 9087661221 |
Fax Number: | 9087669577 |
NPI Enumeration Date: | 02/25/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 35SI00170200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |