Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY12868 | CA |
N | 103TC0700X | Clinical Psychologist | PSY12868 | CA |
Y | 103G00000X | Clinical Psychologist | PY60196503 | WA |
Y | 103TC0700X | Clinical Psychologist | PY60196503 | WA |
NPI | 1003115429 |
---|---|
Provider Name | Dr. Daniel Stephen Benveniste |
First Address | Bellevue, WA 98008-5928 |
Second Address | Bellevue, WA 98004-6934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2011 |
Last Update Date | 17/06/2013 |