Provider Demographics
NPI:1700204658
Name:BENAS, NICK (QMHA)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:BENAS
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 EXCHANGE ST
Mailing Address - Street 2:4
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3847
Mailing Address - Country:US
Mailing Address - Phone:503-440-4037
Mailing Address - Fax:
Practice Address - Street 1:2120 EXCHANGE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3365
Practice Address - Country:US
Practice Address - Phone:503-325-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner