Healthcare Provider Details

I. General information

NPI: 1083196331
Provider Name (Legal Business Name): JODI BENATOVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 ELLICOTT ST
BATAVIA NY
14020-3650
US

IV. Provider business mailing address

55 DODGE RD
GETZVILLE NY
14068-1205
US

V. Phone/Fax

Practice location:
  • Phone: 585-815-0247
  • Fax:
Mailing address:
  • Phone: 716-831-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: