Provider Demographics
NPI:1487942660
Name:BENITEZ, WENDY MARICELA
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MARICELA
Last Name:BENITEZ
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 1:289 HAVRE ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-3029
Mailing Address - Country:US
Mailing Address - Phone:617-912-7637
Mailing Address - Fax:
Practice Address - Street 1:130 CONDOR ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1305
Practice Address - Country:US
Practice Address - Phone:617-569-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator