Peter Sylvester Bennett, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071005983 Issued in IL

Practice address

1747 W Roosevelt Rd # 747
Room 155
Chicago, IL 60608-1264

Phone

(312) 413-1371

Fax

(312) 413-1036

NPI assigned

Feb 10, 2008

Last updated

Feb 10, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Prof. Jaleel Abdul-Adil Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1202601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202601600000",
    "number": "1902084189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 W ROOSEVELT RD # 747",
            "address_2": "ROOM 155",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081264",
            "telephone_number": "312-413-1371",
            "fax_number": "312-413-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 W ROOSEVELT RD # 747",
            "address_2": "ROOM 155",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081264",
            "telephone_number": "312-413-1371",
            "fax_number": "312-413-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "PETER",
        "middle_name": "SYLVESTER",
        "name_prefix": "Prof.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-10",
        "last_updated": "2008-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JALEEL",
            "last_name": "ABDUL-ADIL",
            "prefix": "PROF.",
            "credential": "PH.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Marc H Bennett, OTRL
• Margaret Bennett
• Nelson E Bennett Jr., MD
• Nikole R Bennett, LCSW
• Noel Miriam Bennett, M.D.
• Rachel Bennett, RN
• Rachel Logan Bennett
• Raymond M Bennett Jr., B.S. PHARM
• Samuel Richard Bennett
• Sarah Bennett

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2008; 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.