Provider Demographics
NPI:1851709471
Name:BENKOVIC, KELLY ANN
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:BENKOVIC
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 1:3866 FIRE BRICK RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9276
Mailing Address - Country:US
Mailing Address - Phone:610-392-8104
Mailing Address - Fax:
Practice Address - Street 1:3866 FIRE BRICK RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9276
Practice Address - Country:US
Practice Address - Phone:610-392-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health