Active NPI
Ryan David Bennett, PSYD
- Clinical Neuropsychologist
- Fort Lauderdale, FL
National Provider Identifier
1427747187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 11602
- Practice address
- 3301 College Avenue
Fort Lauderdale, FL 33314 - Phone
- (404) 307-2979
- NPI assigned
- May 8, 2023
- Last updated
- May 8, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 11602 | FL | Primary |
Addresses
Primary practice location
3301 College Avenue
Fort Lauderdale, FL 33314
Mailing address
725 NW 156TH Ave
Pembroke Pines, FL 33028
Phone (404) 307-2979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11602 | FL | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1427747187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 NW 156TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "33028",
"telephone_number": "404-307-2979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 COLLEGE AVENUE",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "33314",
"telephone_number": "404-307-2979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "RYAN",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "FL",
"license": "11602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.