Provider Demographics
NPI:1508992959
Name:BENOIT, KRISTEN N (LM)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:BENOIT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12978-1704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 CLINTON ST
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:NY
Practice Address - Zip Code:12978-1704
Practice Address - Country:US
Practice Address - Phone:518-314-6664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1070000028176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012130Medicaid