Provider Demographics
NPI:1619467164
Name:KIRENIA BENABE LLC
Entity Type:Organization
Organization Name:KIRENIA BENABE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TCM
Authorized Official - Prefix:
Authorized Official - First Name:KIRENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-663-6192
Mailing Address - Street 1:7195 SPOONFOOT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5810
Mailing Address - Country:US
Mailing Address - Phone:321-663-6192
Mailing Address - Fax:
Practice Address - Street 1:7195 SPOONFOOT ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5810
Practice Address - Country:US
Practice Address - Phone:321-663-6192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty