Mavis Bennett, PSYCHOLOGIST

Primary specialty

PsychologistTaxonomy code 103T00000X

License

MT1268 Issued in FL

Practice address

1100 S Ponce de Leon Blvd Ste 1
St Augustine, FL 32084-6013

Phone

(904) 824-7733

Fax

(904) 829-9768

NPI assigned

Oct 24, 2006

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1003999608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 S PONCE DE LEON BLVD STE 1",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320846013",
            "telephone_number": "904-824-7733",
            "fax_number": "904-829-9768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S PONCE DE LEON BLVD STE 1",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320846013",
            "telephone_number": "904-824-7733",
            "fax_number": "904-829-9768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "MAVIS",
        "name_prefix": "Mrs.",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "MT1268",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "FL",
            "license": "MT1268",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beltone Northern Florida
• John David Bendt, OPA-C
• Shadisha K Bennett Brodde, LPC
• Bisona Yeba Bennett, DNP, APRN, FNP-C
• Cole Reilly Bennett
• Nancy Frances Bent, ED.D.
• Diana Carol Beranek
• Mary Geary Berdellans, PHARMD
• Russell Berger
• Elizabeth Margaret Bergman, DPT

• Psychologist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.