Provider Demographics
NPI:1588319271
Name:BENTON, JANET GLEASON I (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:GLEASON
Last Name:BENTON
Suffix:I
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 79TH ST APT 10WR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6100
Mailing Address - Country:US
Mailing Address - Phone:917-658-5982
Mailing Address - Fax:
Practice Address - Street 1:310 W 79TH ST APT 10WR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6100
Practice Address - Country:US
Practice Address - Phone:917-658-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical