Provider Demographics
NPI:1831486836
Name:BENAVENTE, ALEXIS PENNACCHIO (BS)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:PENNACCHIO
Last Name:BENAVENTE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W HEALEY ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5025
Mailing Address - Country:US
Mailing Address - Phone:217-398-1658
Mailing Address - Fax:
Practice Address - Street 1:614 W HEALEY ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5025
Practice Address - Country:US
Practice Address - Phone:217-398-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker