Provider Demographics
NPI:1336426568
Name:OSCAR J. BENITEZ, PHD INC
Entity Type:Organization
Organization Name:OSCAR J. BENITEZ, PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-228-3558
Mailing Address - Street 1:1601 114TH AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6904
Mailing Address - Country:US
Mailing Address - Phone:425-246-6891
Mailing Address - Fax:425-533-2515
Practice Address - Street 1:1601 114TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6904
Practice Address - Country:US
Practice Address - Phone:425-246-6891
Practice Address - Fax:425-533-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60251767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty