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Individual

MR. ELLIOTT BENAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA

Contact information

Practice address
85 ALPINE DR, JERICHO, VT 05465-2071
(802) 899-3558
(802) 899-1726
Mailing address
85 ALPINE DR, JERICHO, VT 05465-2071
(802) 899-3558
(802) 899-1726

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
047-0000024
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0006534
VT
Enumeration date
09/12/2005
Last updated
03/27/2008
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