Provider Demographics
NPI:1407926363
Name:BENAK, RITA A (MS, LICENSED PSYCH)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:A
Last Name:BENAK
Suffix:
Gender:F
Credentials:MS, LICENSED PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 WAYZATA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2053
Mailing Address - Country:US
Mailing Address - Phone:952-593-3627
Mailing Address - Fax:763-780-5821
Practice Address - Street 1:11900 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2053
Practice Address - Country:US
Practice Address - Phone:952-593-3627
Practice Address - Fax:763-780-5821
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical