Provider Demographics
NPI:1619940301
Name:BENVENISTE, DEBRA HENRIETTE (MSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:HENRIETTE
Last Name:BENVENISTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:1039 NORTH MAIN STREET
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241
Mailing Address - Country:US
Mailing Address - Phone:860-774-2365
Mailing Address - Fax:
Practice Address - Street 1:1039 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-2170
Practice Address - Country:US
Practice Address - Phone:860-774-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP3592342OtherOXFORD HEALTH PLANS
CT004201638Medicaid
CT134225OtherVALUE OPTIONS
CT140002203CT03OtherANTHEM BCBS
CT167743OtherMHN
CT62 43455OtherBCBS RI
CT800000954Medicare ID - Type Unspecified