Elizabeth Bennett

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-20-44478

Practice address

10 Southwood Dr
Edgewood, NM 87015-7100

Phone

(405) 905-0881

NPI assigned

Sep 6, 2018

Last updated

Feb 23, 2022By 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

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

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1043792997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9930 N EL UNO MINOR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857439788",
            "telephone_number": "140-590-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SOUTHWOOD DR",
            "city": "EDGEWOOD",
            "state": "NM",
            "postal_code": "870157100",
            "telephone_number": "405-905-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-06",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-20-44478",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Eva Mae Blakely, MS/CCC-SLP
• Krystal Marie Blanton
• Monica Briones, M.D.

• Behavior Analyst in Edgewood, NM
• Providers in Edgewood, NM by specialty
• Behavior Analyst in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.