| Doctor Name: | KELLY BENCIVENNI |
| NPI Number: | 1184087702 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | S0027604 |
| Business Practice Address: | 695 South St Suite 6 Chardon, OH - 440241474 |
| Business Phone Number: | 4402861553 |
| Business Fax Number: | 4402861318 |
| Mailing Address: | 695 South St, Suite 6 CHARDON |
| State: | OH |
| Postal Code: | 440241474 |
| Phone Number: | 4402861553 |
| Fax Number: | 4402861318 |
| NPI Enumeration Date: | 03/31/2016 |
| NPI Last Update Date: | 03/31/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | S0027604 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |