Provider Demographics
NPI:1649020371
Name:BENITEZ PERAZA, KATHERINE PATRICIA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PATRICIA
Last Name:BENITEZ PERAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 AGER RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1632
Mailing Address - Country:US
Mailing Address - Phone:240-614-6840
Mailing Address - Fax:
Practice Address - Street 1:4217 STAFFORD RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2144
Practice Address - Country:US
Practice Address - Phone:202-240-7027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRBT-21-174696103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst