Provider Demographics
NPI:1740932565
Name:BENJEY, OLIVIA MCMAHON
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MCMAHON
Last Name:BENJEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 VINEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2763
Mailing Address - Country:US
Mailing Address - Phone:734-780-6216
Mailing Address - Fax:
Practice Address - Street 1:2217 VINEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2763
Practice Address - Country:US
Practice Address - Phone:734-780-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician