Provider Demographics
NPI:1780411454
Name:BENICK, STACIE
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:BENICK
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 1:25 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:HELMETTA
Mailing Address - State:NJ
Mailing Address - Zip Code:08828-1162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 MADISON DR
Practice Address - Street 2:
Practice Address - City:HELMETTA
Practice Address - State:NJ
Practice Address - Zip Code:08828-1162
Practice Address - Country:US
Practice Address - Phone:646-450-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health