Provider Demographics
NPI:1689099509
Name:BENAMI, ELAN (MA)
Entity Type:Individual
Prefix:
First Name:ELAN
Middle Name:
Last Name:BENAMI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 FEDERAL BLVD UNIT 1/2
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4255
Mailing Address - Country:US
Mailing Address - Phone:303-218-8515
Mailing Address - Fax:
Practice Address - Street 1:2719 FEDERAL BLVD UNIT 1/2
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4255
Practice Address - Country:US
Practice Address - Phone:303-218-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0013968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health