Provider Demographics
NPI:1932925146
Name:BENITEZ MARQUEZ, MASSIEL ELENA
Entity type:Individual
Prefix:
First Name:MASSIEL
Middle Name:ELENA
Last Name:BENITEZ MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8716 SW 145TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8037
Mailing Address - Country:US
Mailing Address - Phone:786-286-1326
Mailing Address - Fax:
Practice Address - Street 1:8716 SW 145TH ST APT 2
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-8037
Practice Address - Country:US
Practice Address - Phone:786-286-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-395865106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician