Provider Demographics
NPI:1821374448
Name:BENBOW, TAKENYA TANYETTE
Entity Type:Individual
Prefix:MISS
First Name:TAKENYA
Middle Name:TANYETTE
Last Name:BENBOW
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 1:5 S LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-3604
Mailing Address - Country:US
Mailing Address - Phone:914-439-4057
Mailing Address - Fax:
Practice Address - Street 1:135 WEST 50TH STREET 6TH FLOOR
Practice Address - Street 2:JEWISH BOARD OF FAMILY AND CHILDREN SERVICES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020
Practice Address - Country:US
Practice Address - Phone:914-773-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children