Provider Demographics
NPI:1326668112
Name:BENEZRA, MAX RYAN (EDM, MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:RYAN
Last Name:BENEZRA
Suffix:
Gender:M
Credentials:EDM, MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROSSWAYS PARK DR N STE 400
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 CROSSWAYS PARK DR N STE 400
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2007
Practice Address - Country:US
Practice Address - Phone:516-387-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health