Provider Demographics
NPI:1720816572
Name:BENWAY, ANGELA G (BCBA; LBA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:G
Last Name:BENWAY
Suffix:
Gender:F
Credentials:BCBA; LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 HIBERNIA RD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-3666
Mailing Address - Country:US
Mailing Address - Phone:518-569-5120
Mailing Address - Fax:
Practice Address - Street 1:233 HIBERNIA RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972-3666
Practice Address - Country:US
Practice Address - Phone:518-569-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003237-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst