Provider Demographics
NPI:1689000945
Name:BENITEZ, TANIA L (MA)
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:L
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 21 U3 -1 URBANIZACION LAS LOMAS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00921
Mailing Address - Country:UM
Mailing Address - Phone:787-942-4277
Mailing Address - Fax:
Practice Address - Street 1:STREET BILBAO # J-28
Practice Address - Street 2:URB VILLA CLEMENTINA
Practice Address - City:GUYANABO
Practice Address - State:PR
Practice Address - Zip Code:00969-0000
Practice Address - Country:US
Practice Address - Phone:787-942-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist