Provider Demographics
NPI:1356566566
Name:BENASH, MARIANNE D (MED)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:D
Last Name:BENASH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 STRATHMORE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3735
Mailing Address - Country:US
Mailing Address - Phone:610-527-5595
Mailing Address - Fax:
Practice Address - Street 1:26 SUMMIT GROVE AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3230
Practice Address - Country:US
Practice Address - Phone:610-527-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 4135-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS 4135-LOtherSTATE LICENSE #