Individual
DR. MARY ANN BENAVIDES
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH D
Contact information
Practice address
7425 MAPLE TERRACE, WAUWATOSA, WI 53213-3154
(414) 475-5815
Mailing address
7425 MAPLE TERRACE, WAUWATOSA, WI 53213-3154
(414) 475-5815
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1319057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39081700
—
WI
Enumeration date
03/20/2006
Last updated
07/08/2007
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