Provider Demographics
NPI:1841420452
Name:BENNAIM, AMANDA WHITNEY
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:WHITNEY
Last Name:BENNAIM
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:PO BOX 6344
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-7344
Mailing Address - Country:US
Mailing Address - Phone:805-441-1825
Mailing Address - Fax:
Practice Address - Street 1:505 N EUCLID ST
Practice Address - Street 2:STE. 300
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5506
Practice Address - Country:US
Practice Address - Phone:714-871-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health