Provider Demographics
NPI:1063106888
Name:BENYACOV, LEANA
Entity type:Individual
Prefix:MS
First Name:LEANA
Middle Name:
Last Name:BENYACOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 RICHMOND AVE # 137
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2123
Mailing Address - Country:US
Mailing Address - Phone:347-902-4209
Mailing Address - Fax:
Practice Address - Street 1:114 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1394
Practice Address - Country:US
Practice Address - Phone:347-902-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst