Provider Demographics
NPI:1275010894
Name:BENCIVENGA, ALYSSA MARIE
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MARIE
Last Name:BENCIVENGA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:BAVARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 WILLOW AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:293 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4801
Practice Address - Country:US
Practice Address - Phone:212-673-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist