Individual
JACQUELYN BENITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
357 EAST ST, PLAINVILLE, CT 06062-3260
(860) 793-9048
Mailing address
357 EAST ST, PLAINVILLE, CT 06062
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XGC0575M20743
BLUE CROSS BLUE SHIELD
CT
Enumeration date
05/16/2019
Last updated
05/16/2019
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