Provider Demographics
NPI:1174969679
Name:BENAVIDES, MIRELLA NATALIE
Entity type:Individual
Prefix:
First Name:MIRELLA
Middle Name:NATALIE
Last Name:BENAVIDES
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 1:10056 SW 117TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8521
Mailing Address - Country:US
Mailing Address - Phone:786-291-1006
Mailing Address - Fax:
Practice Address - Street 1:10056 SW 117TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8521
Practice Address - Country:US
Practice Address - Phone:786-291-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst