Provider Demographics
NPI:1770284150
Name:EUSTACHE, BENETTY ALTENOR
Entity type:Individual
Prefix:
First Name:BENETTY
Middle Name:ALTENOR
Last Name:EUSTACHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BENETTY
Other - Middle Name:ALTENOR
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2036
Mailing Address - Country:US
Mailing Address - Phone:781-913-7261
Mailing Address - Fax:
Practice Address - Street 1:5 GARLAND AVE
Practice Address - Street 2:N/A
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2036
Practice Address - Country:US
Practice Address - Phone:781-913-7261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician