Provider Demographics
NPI:1467040113
Name:BENLOLO, MELANIA
Entity Type:Individual
Prefix:
First Name:MELANIA
Middle Name:
Last Name:BENLOLO
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 1:19955 NE 38TH CT APT 1103
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3455
Mailing Address - Country:US
Mailing Address - Phone:305-934-9495
Mailing Address - Fax:
Practice Address - Street 1:19955 NE 38TH CT APT 1103
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3455
Practice Address - Country:US
Practice Address - Phone:305-934-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty