Healthcare Provider Details

I. General information

NPI: 1326634031
Provider Name (Legal Business Name): JAMIAH BENBERRY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 ORIENTA AVE
ALTAMONTE SPRINGS FL
32701-5619
US

IV. Provider business mailing address

745 ORIENTA AVE
ALTAMONTE SPRINGS FL
32701-5619
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax: 352-332-8589
Mailing address:
  • Phone: 877-823-4283
  • Fax: 352-332-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-148487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: