MEDICARE: MS. KRISTEN J BENAVITCH LAC, NCC

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	101YM0800X	Mental Health Counselor	37AC00918900	NJ

General Provider Information

NPI Number	:	1477405884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN J BENAVITCH LAC, NCC

Provider Business Mailing Address
First Line	:	1114 BYRON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-1027
Country	:	US
Telephone Number	:	908-652-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 BYRON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-1027
Country	:	US
Telephone Number	:	908-652-4999
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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