Bennett, Robert Todd

Bennett, Robert Todd is an individual health care provider with primary practice located at 1755 Westgate Dr Suite 260, Boise ID 83704-7174. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Bennett, Robert Todd can be contacted via phone (208) 373-0790.

Contact Information

Primary practice address
1755 Westgate Dr Suite 260 Boise ID 83704-7174
Phone: (208) 373-0790
Fax: (208) 373-0816
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY-411 Idaho

Profile Details

NPI number 1962490474
LBN Legal business name Bennett, Robert Todd
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2005
Last updated May 3rd, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962490474 NPPES
Idaho Other 00010031804 REGENCE BLUE SHIELD
Idaho Other N5491 REGENCE BLUE SHIELD

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