Provider Demographics
NPI:1003115429
Name:BENVENISTE, DANIEL STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:STEPHEN
Last Name:BENVENISTE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 173RD PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5928
Mailing Address - Country:US
Mailing Address - Phone:425-455-0882
Mailing Address - Fax:
Practice Address - Street 1:1450 114TH AVE SE STE 105
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6934
Practice Address - Country:US
Practice Address - Phone:425-455-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60196503103TC0700X
CAPSY12868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical