Provider Demographics
NPI:1225577240
Name:BENHAM, ANJALIQUE
Entity Type:Individual
Prefix:
First Name:ANJALIQUE
Middle Name:
Last Name:BENHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LANCELOT CT
Mailing Address - Street 2:APT#1
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3555
Mailing Address - Country:US
Mailing Address - Phone:781-600-5596
Mailing Address - Fax:
Practice Address - Street 1:5 LANCELOT CT
Practice Address - Street 2:APT#1
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3555
Practice Address - Country:US
Practice Address - Phone:781-600-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty