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General NPI Number Information
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NPI Number | 1225620578
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Entity Type | Individual
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Provider Name | CAMILLE BENITO PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 5551 N UNIVERSITY DR STE 202
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4651
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Country | US
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Telephone | 954-755-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 400 CAPITAL CIR SE STE 18283
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City | TALLAHASSEE
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State | FL
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Zip | 32301-3802
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Country | US
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Telephone | 954-866-4329
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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 | PY10983
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License Number State | FL
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