Provider Demographics
NPI:1790979250
Name:BENZAQUEN, JULIE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:S
Last Name:BENZAQUEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6543
Mailing Address - Country:US
Mailing Address - Phone:513-481-7500
Mailing Address - Fax:
Practice Address - Street 1:3345 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6543
Practice Address - Country:US
Practice Address - Phone:513-481-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB10000771103TC0700X
PAPS016538103TC0700X
OH6743103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0141933Medicaid
MD4134869Medicaid