Provider Demographics
NPI:1922450543
Name:BENZO, RAS (CPT/CFL)
Entity Type:Individual
Prefix:MR
First Name:RAS
Middle Name:
Last Name:BENZO
Suffix:
Gender:M
Credentials:CPT/CFL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13517 UPHAM ST
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-4208
Mailing Address - Country:US
Mailing Address - Phone:571-330-2384
Mailing Address - Fax:
Practice Address - Street 1:13517 UPHAM ST
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-4208
Practice Address - Country:US
Practice Address - Phone:571-330-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No174H00000XOther Service ProvidersHealth Educator