Healthcare Provider Details

I. General information

NPI: 1437635588
Provider Name (Legal Business Name): ABLA BENCHAMKHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3239 PLAYERS CLUB PKWY
MEMPHIS TN
38125-8845
US

IV. Provider business mailing address

PO BOX 360595
PITTSBURGH PA
15251-6595
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-5311
  • Fax:
Mailing address:
  • Phone: 718-215-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-30826
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15537
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: