Provider Demographics
NPI:1104161926
Name:BENHALIM, INTISSAR A (LSW)
Entity type:Individual
Prefix:MRS
First Name:INTISSAR
Middle Name:A
Last Name:BENHALIM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N MATLACK ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2620
Mailing Address - Country:US
Mailing Address - Phone:610-696-4900
Mailing Address - Fax:
Practice Address - Street 1:310 N MATLACK ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2620
Practice Address - Country:US
Practice Address - Phone:610-696-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100743608Medicaid
PA1487745386Medicare PIN