Healthcare Provider Details

I. General information

NPI: 1902810328
Provider Name (Legal Business Name): BENITA K CHERNYK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 ROCKSIDE RD STE 600
INDEPENDENCE OH
44131-6827
US

IV. Provider business mailing address

PO BOX 202653
CLEVELAND OH
44120-8127
US

V. Phone/Fax

Practice location:
  • Phone: 216-382-2929
  • Fax: 216-751-8348
Mailing address:
  • Phone: 216-382-2929
  • Fax: 216-751-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number933731
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4412
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number933731
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: