Provider Demographics
NPI:1417640418
Name:BENOIT, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:BENOIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 CEDARSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1655
Mailing Address - Country:US
Mailing Address - Phone:443-823-8243
Mailing Address - Fax:
Practice Address - Street 1:4041 CEDARSIDE DR
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1655
Practice Address - Country:US
Practice Address - Phone:443-823-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health