Provider Demographics
NPI:1821276460
Name:BENJAMIN, KELLY LYNNE
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYNNE
Last Name:BENJAMIN
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 1:942 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2109
Mailing Address - Country:US
Mailing Address - Phone:714-399-1860
Mailing Address - Fax:714-399-1867
Practice Address - Street 1:942 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2109
Practice Address - Country:US
Practice Address - Phone:714-399-1860
Practice Address - Fax:714-399-1867
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator