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General NPI Number Information
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NPI Number | 1003115429
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Entity Type | Individual
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Provider Name | DANIEL STEPHEN BENVENISTE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 1450 114TH AVE SE STE 105
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City | BELLEVUE
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State | WA
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Zip | 98004-6934
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Country | US
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Telephone | 425-455-0882
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Fax |
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Provider Business Mailing Address
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Address Line | 4096 173RD PL SE
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City | BELLEVUE
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State | WA
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Zip | 98008-5928
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Country | US
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Telephone | 425-455-0882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60196503
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY12868
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License Number State | CA
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