Provider Demographics
NPI:1922649557
Name:BENINCASA, CHARLES ANTHONY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:BENINCASA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 W MARINE VIEW DR STE 109
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2094
Mailing Address - Country:US
Mailing Address - Phone:425-285-8353
Mailing Address - Fax:888-240-5967
Practice Address - Street 1:1728 W MARINE VIEW DR STE 109
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2094
Practice Address - Country:US
Practice Address - Phone:425-285-8353
Practice Address - Fax:888-240-5967
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY.61155333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist