Provider Demographics
NPI:1306191648
Name:BENITEZ, NATASHA GLORIA
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:GLORIA
Last Name:BENITEZ
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 1:4975 E SABAL PALM BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2648
Mailing Address - Country:US
Mailing Address - Phone:845-709-1265
Mailing Address - Fax:
Practice Address - Street 1:4975 E SABAL PALM BLVD APT 101
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2648
Practice Address - Country:US
Practice Address - Phone:845-709-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst