MEDICARE: DR. ZIVA BENEZRA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY1000681	DC

General Provider Information

NPI Number	:	1841476322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZIVA BENEZRA PSY.D.

Provider Business Mailing Address
First Line	:	1350 CONNECTICUT AVE NW STE 612
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-1735
Country	:	US
Telephone Number	:	202-999-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 CONNECTICUT AVE NW STE 612
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-1735
Country	:	US
Telephone Number	:	202-999-8423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	09/07/2022

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