Provider Demographics
NPI:1811156177
Name:SMITH, BENAY P (APRN)
Entity type:Individual
Prefix:MRS
First Name:BENAY
Middle Name:P
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351 1000 SILVER STREET
Mailing Address - Street 2:RIVER VALLEY SERVICES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-0351
Mailing Address - Country:US
Mailing Address - Phone:860-262-5225
Mailing Address - Fax:
Practice Address - Street 1:351 SILVER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3919
Practice Address - Country:US
Practice Address - Phone:860-262-5296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002458364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT890000432Medicare PIN