Healthcare Provider Details

I. General information

NPI: 1831560010
Provider Name (Legal Business Name): MARK BENISZ PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 ROUTE 45 STE 204A
NEW CITY NY
10956-1124
US

IV. Provider business mailing address

5 DEERWOOD RD
SPRING VALLEY NY
10977-1002
US

V. Phone/Fax

Practice location:
  • Phone: 845-293-2345
  • Fax:
Mailing address:
  • Phone: 845-782-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021363
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number021363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: