Individual
ANGELA MARIE BENAVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 US-6, IOWA CITY, IA 52246
(319) 338-0581
Mailing address
4824 E 53RD ST APT 408, MINNEAPOLIS, MN 55417-5004
(716) 870-7040
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
022609-1
NY
103TP2701X
Group Psychotherapy Psychologist
022609-1
NY
103TR0400X
Rehabilitation Psychologist
022609-1
NY
Other
Enumeration date
07/20/2018
Last updated
07/20/2018
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