Provider Demographics
NPI:1467067801
Name:BENZAL, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BENZAL
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 1:10311 68TH DR APT 1M
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3149
Mailing Address - Country:US
Mailing Address - Phone:845-492-0674
Mailing Address - Fax:
Practice Address - Street 1:8974 162ND ST STE 5
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5012
Practice Address - Country:US
Practice Address - Phone:347-931-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical