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General NPI Number Information
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NPI Number | 1043479454
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Entity Type | Individual
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Provider Name | JACQUELYN DENISE BENIQUEZ LMHC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 10 MCKOWN RD STE 102
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City | ALBANY
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State | NY
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Zip | 12203-3496
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Country | US
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Telephone | 518-210-7707
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Fax |
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Provider Business Mailing Address
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Address Line | 162 CEDARVIEW LN
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City | WATERVLIET
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State | NY
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Zip | 12189-2954
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Country | US
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Telephone | 518-210-7707
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 001784-1
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License Number State | NY
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