Jeanne Marie Bennett, PSY.D.

Key facts

NPI

1164429320

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Neuropsychologist 103G00000X

License

129055 (KY)

Practice address

1169 Eastern Pkwy Ste 2238
Louisville, KY 40217-1444

Phone

(502) 376-7552

Fax

(502) 425-5540

NPI assigned

Jul 2, 2005

Sex

Female

Sole proprietor

No

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edelson and Associates, Inc. Clinical Neuropsychologist · Louisville, KY · NPI 1952466468
  NPD (past) CLINICAL NEUROPSYCHOLOGIST
• Larry M. Raskin, PH.D., P.S.C. Psychologist · Louisville, KY · NPI 1952389389
  NPD (past)
• Marilyn M. Wagner PH.D., PSC Clinical Neuropsychologist · Louisville, KY · NPI 1265689475
  NPD (past) CLINICAL NEUROPSYCHOLOGIST
• Optum Behavioral Care of North Carolina, P.C. Clinical Social Worker · Gulfport, MS · NPI 1861371718
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 1, 2017.

{
    "created_epoch": "1120262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504224000000",
    "number": "1164429320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9012 WILLOW SPRINGS DRIVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402427763",
            "telephone_number": "502-376-7552",
            "fax_number": "502-425-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1169 EASTERN PKWY STE 2238",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171444",
            "telephone_number": "502-376-7552",
            "fax_number": "502-425-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JEANNE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-02",
        "last_updated": "2017-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "KY",
            "license": "1034",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "1034",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "KY",
            "license": "129055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7020285",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89000061",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000376778",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

• Donald Walter Bennett, OD MD
• Gary Dale Bennett, COTA
• Jacqueline Hilda Bennett, OT
• James Francis Bennett, DDS
• Jasmin Nicole Bennett
• Jesslyn Bennett, RBT
• Johnathan Lucas Bennett, CADCA I
• Johnna Bennett
• Laura Bennett
• Laura Bennett

All providers in Louisville, KY · Clinical Neuropsychologist in Kentucky