MEDICARE: CAROL BENCIVENGA

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	IMH13487	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADC-010338-2015	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790220069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL BENCIVENGA

Provider Business Mailing Address
First Line	:	1022 BRIELLE AVE
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-5400
Country	:	US
Telephone Number	:	407-461-6179
Fax Number	:	407-366-8108

Provider Business Practice Location Address
First Line	:	1022 BRIELLE AVE
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-5400
Country	:	US
Telephone Number	:	407-461-6179
Fax Number	:	407-366-8108

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

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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Directions to “ CAROL BENCIVENGA ” Practice Location

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