Provider Demographics
NPI:1255479077
Name:BENVENISTI, HENRY (PHD CLINICAL PSYCH)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:BENVENISTI
Suffix:
Gender:M
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N MIDDLETOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645
Mailing Address - Country:US
Mailing Address - Phone:201-391-9467
Mailing Address - Fax:
Practice Address - Street 1:48 N MIDDLETOWN ROAD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645
Practice Address - Country:US
Practice Address - Phone:201-391-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY667PZ8832103TA0400X
NJ37F100036900106H00000X
NJ103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103066OtherVALUE OPTIONS OF NY
NY0059327OtherGHI OF NY
NJVZ6881OtherBLUE CROSS
NJHB699478Medicaid
NY103066OtherVALUE OPTIONS OF NY