Provider Demographics
NPI:1376537860
Name:BENAY, ELLIOTT (MA)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:
Last Name:BENAY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2071
Mailing Address - Country:US
Mailing Address - Phone:802-899-3558
Mailing Address - Fax:802-899-1726
Practice Address - Street 1:85 ALPINE DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-2071
Practice Address - Country:US
Practice Address - Phone:802-899-3558
Practice Address - Fax:802-899-1726
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006534Medicaid