Healthcare Provider Details

I. General information

NPI: 1326959222
Provider Name (Legal Business Name): ROSANA BENITEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 ARCADIA DR STE 100-125
FREDERICK MD
21703-7662
US

IV. Provider business mailing address

1803 GREENSPRING PL UNIT 205
FREDERICK MD
21702-6013
US

V. Phone/Fax

Practice location:
  • Phone: 301-291-8585
  • Fax:
Mailing address:
  • Phone: 301-291-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: