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J BENNETT GROUP PSC

Clinical Neuropsychologist

Louisville, Kentucky

Provider NPI: 1790955334

Organization Information:
Organization Name:  J BENNETT GROUP PSC
Organization is not Subpart
Authorized Official:  JEANNE M BENNETT  PRES/CEO  502-3767552

Practice Location:
1169 EASTERN PKWY STE 2238  LOUISVILLE, KY 40217 US
Tel: 502-376-7552  Fax: 502-425-5540

Business Mailing Address:
1603 STEVENS AVE SUITE 202 LOUISVILLE, KY 40205 US
Tel: (50-2) -376-7552  Fax: 502-425-5540

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
KY1034
N103TC0700XBehavioral Health & Social Service Providers
Psychologist
KY1034
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
KY129055

Other Provider Identifiers:

IssuerNumberStateType
AETNA7944828KY01
PASSPORT HEALTH50107908KY01
ANTHEM000000376780KY01
89900344KY05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS KY - Page 1



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