Provider Demographics
NPI:1760114607
Name:RIOS-BENITEZ, NYDIA
Entity Type:Individual
Prefix:
First Name:NYDIA
Middle Name:
Last Name:RIOS-BENITEZ
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 1:760 HOPMEADOW ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2299
Mailing Address - Country:US
Mailing Address - Phone:860-490-5189
Mailing Address - Fax:
Practice Address - Street 1:760 HOPMEADOW ST STE 210
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2299
Practice Address - Country:US
Practice Address - Phone:860-490-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health