Provider Demographics
NPI:1518151232
Name:BENOWITZ, JACQUELINE (MS MFT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BENOWITZ
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:PENNDEL
Mailing Address - State:PA
Mailing Address - Zip Code:19047-5707
Mailing Address - Country:US
Mailing Address - Phone:215-752-1541
Mailing Address - Fax:
Practice Address - Street 1:1517 DURHAM RD
Practice Address - Street 2:
Practice Address - City:PENNDEL
Practice Address - State:PA
Practice Address - Zip Code:19047-5707
Practice Address - Country:US
Practice Address - Phone:215-752-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432016096390200000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program