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NPI Code Detail

MEDICARE: CHRISTINE MICHELLE BENVENUTO MA

MEDICARE: CHRISTINE MICHELLE BENVENUTO MA
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
1106H00000XMarriage & Family TherapistMFC42013CA

General Provider Information

NPI Number : 1649317074
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE MICHELLE BENVENUTO MA
Provider Business Mailing Address
First Line : 5520 LAWTON AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94618-1509
Country : US
Telephone Number : 510-421-6766
Fax Number :
Provider Business Practice Location Address
First Line : 3301 E 12TH ST STE 259
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2940
Country : US
Telephone Number : 510-269-9030
Fax Number : 510-269-9031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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Directions to “ CHRISTINE MICHELLE BENVENUTO MA” Practice Location

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