Provider Demographics
NPI:1306249560
Name:BENIGNO, VANESSA (BCBA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BENIGNO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4603 NAAMANS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-2214
Mailing Address - Country:US
Mailing Address - Phone:610-800-1168
Mailing Address - Fax:
Practice Address - Street 1:4603 NAAMANS CREEK RD
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-2214
Practice Address - Country:US
Practice Address - Phone:610-800-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000763103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst