Healthcare Provider Details

I. General information

NPI: 1043488828
Provider Name (Legal Business Name): MS. JESSICA L BENASKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WATER ST SUITE B-236
PLYMOUTH MA
02360-4060
US

IV. Provider business mailing address

225 WATER ST SUITE B-236
PLYMOUTH MA
02360-4060
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-6302
  • Fax: 508-747-6304
Mailing address:
  • Phone: 508-747-6302
  • Fax: 508-747-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: