Individual
IVY BENCIVENGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
10427 DETROIT AVE, CLEVELAND, OH 44102-1645
(216) 487-2168
Mailing address
27068 OAKWOOD DR APT 119B, OLMSTED TWP, OH 44138-1189
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
C.2002641
OH
Other
Enumeration date
06/12/2019
Last updated
12/13/2021
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