MEDICARE: PABLO XAVIER BENAVIDES 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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1871680181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO XAVIER BENAVIDES MA

Provider Business Mailing Address
First Line	:	226 OGDEN AVE APT 3B
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-1223
Country	:	US
Telephone Number	:	917-407-1599
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 W 86TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-4018
Country	:	US
Telephone Number	:	212-362-8755
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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Directions to “ PABLO XAVIER BENAVIDES MA” Practice Location

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