Provider Demographics
NPI:1407924491
Name:BENKO, SUZANNE REBECCA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:REBECCA
Last Name:BENKO
Suffix:
Gender:
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 EAGLEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1157
Mailing Address - Country:US
Mailing Address - Phone:949-293-5010
Mailing Address - Fax:
Practice Address - Street 1:126 POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9516
Practice Address - Country:US
Practice Address - Phone:949-293-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28262106H00000X
PAMF001272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA562387949OtherTAX IDENTIFICATION NUMBER