Provider Demographics
NPI:1720485790
Name:BENKO, MATTHEW (NCC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:BENKO
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BLACKHORSE HILL RD.
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2096
Mailing Address - Country:US
Mailing Address - Phone:610-384-7711
Mailing Address - Fax:610-466-2242
Practice Address - Street 1:1400 BLACKHORSE HILL RD.
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2096
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:610-466-2242
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA343819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional