Doctor Name: | SAMANTHA BENVENUTO |
NPI Number: | 1104256254 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 69476 |
Business Practice Address: | 925 Bear Corbitt Rd Bear, DE - 197011323 |
Business Phone Number: | 3024542400 |
Business Fax Number: | 3024545442 |
Mailing Address: | 925 Bear Corbitt Rd, BEAR |
State: | DE |
Postal Code: | 197011323 |
Phone Number: | 3024542400 |
Fax Number: | 3024545442 |
NPI Enumeration Date: | 11/26/2013 |
NPI Last Update Date: | 11/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 69476 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DE |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |