Provider Demographics
NPI:1730293739
Name:BENVENISTE, PAUL S (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:BENVENISTE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 FIELDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7770
Mailing Address - Country:US
Mailing Address - Phone:518-321-2060
Mailing Address - Fax:518-792-5235
Practice Address - Street 1:75 RAILROAD PL
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2124
Practice Address - Country:US
Practice Address - Phone:518-321-3613
Practice Address - Fax:518-792-5235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0007467211OtherAETNA
61-31845OtherUNITED HEALTHCARE SERVICES
NYVA109OtherEMPIRE BLUE CROSS