Bert Bennett III, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1361 Issued in NC

Practice address

3111 Maplewood Ave
Suite 105
Winston-Salem, NC 27103-3906

Phone

(336) 624-6412

Fax

(336) 724-3839

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Family Behavioral Health, PLLC

  • Psychiatry Physician
  • Winston Salem, NC
  • NPI 1659591162
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1750323705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1684 CHICKASHA DR",
            "city": "PFAFFTOWN",
            "state": "NC",
            "postal_code": "270408210",
            "telephone_number": "336-638-1812",
            "fax_number": "336-946-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 MAPLEWOOD AVE",
            "address_2": "SUITE 105",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271033906",
            "telephone_number": "336-624-6412",
            "fax_number": "336-724-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "BERT",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NC",
            "license": "1361",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "1361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000742",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anjanette Gilley Benjamin, MS, LPCA
• Alisha Beth Benner, M.D.
• Abigail Di Woodard Bennett
• Angela Paige Bennett, MD
• Barbara A Bennett, PA
• Briton Malcom Bennett
• Dana Henley Bennett
• Jerry L Bennett, MD
• Justin Bennett, M.D.
• Katetia H Bennett

• Psychologist in Winston-Salem, NC
• Providers in Winston-Salem, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; 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.