Provider Demographics
NPI:1811036445
Name:BENITEZ, SARA (MA)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 N MAGNOLIA AVE
Mailing Address - Street 2:SUITE 234
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3840
Mailing Address - Country:US
Mailing Address - Phone:407-739-5208
Mailing Address - Fax:407-246-1937
Practice Address - Street 1:934 N MAGNOLIA AVE
Practice Address - Street 2:SUITE 234
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3840
Practice Address - Country:US
Practice Address - Phone:407-739-5208
Practice Address - Fax:407-246-1937
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL298917Medicaid