Provider Demographics
NPI:1104103423
Name:BENITEZ, OSCAR JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:JOSEPH
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:OJ
Other - Middle Name:
Other - Last Name:BENITEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1601 114TH AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6904
Mailing Address - Country:US
Mailing Address - Phone:425-246-6891
Mailing Address - Fax:425-533-2515
Practice Address - Street 1:1601 114TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6904
Practice Address - Country:US
Practice Address - Phone:425-246-6891
Practice Address - Fax:425-533-2515
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60251767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical