Provider Demographics
NPI:1275205361
Name:BENVENUTO, MARILYN VERONICA (MT-BC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:VERONICA
Last Name:BENVENUTO
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2050 WEST CHESTER PIKE
Mailing Address - Street 2:STE 115
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2742
Mailing Address - Country:US
Mailing Address - Phone:610-449-9669
Mailing Address - Fax:610-449-5566
Practice Address - Street 1:2050 WEST CHESTER PIKE
Practice Address - Street 2:STE 115
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2742
Practice Address - Country:US
Practice Address - Phone:610-449-9669
Practice Address - Fax:610-449-5566
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA16247225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist