MEDICARE: DR. RILEY BENKO PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	A0488	MD

General Provider Information

NPI Number	:	1063996247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RILEY BENKO PSY.D.

Provider Business Mailing Address
First Line	:	3828 ELM AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21211-2102
Country	:	US
Telephone Number	:	708-415-4144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1190 WINTERSON RD STE 160
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-2245
Country	:	US
Telephone Number	:	410-684-3406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	09/24/2018

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