Provider Demographics
NPI:1023266277
Name:PAREDES, BENITA (SE/TSHH)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:PAREDES
Suffix:
Gender:F
Credentials:SE/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 IRWIN AVE APT 7D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3828
Mailing Address - Country:US
Mailing Address - Phone:646-423-3288
Mailing Address - Fax:
Practice Address - Street 1:3130 IRWIN AVE APT 7D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3828
Practice Address - Country:US
Practice Address - Phone:646-423-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services