Provider Demographics
NPI:1467732396
Name:BENITEZSANTIAGO, ANGELA STEFANIE (MA, BCABA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:STEFANIE
Last Name:BENITEZSANTIAGO
Suffix:
Gender:F
Credentials:MA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 TURMAN LOOP
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7794
Mailing Address - Country:US
Mailing Address - Phone:813-345-8584
Mailing Address - Fax:813-345-8529
Practice Address - Street 1:3717 TURMAN LOOP
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7794
Practice Address - Country:US
Practice Address - Phone:813-345-8584
Practice Address - Fax:813-345-8529
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-10-3962103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst