Provider Demographics
NPI:1235939950
Name:BENANTAR, LYNA
Entity type:Individual
Prefix:
First Name:LYNA
Middle Name:
Last Name:BENANTAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BROOM SHOP LN APT 101
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2218
Mailing Address - Country:US
Mailing Address - Phone:518-238-5927
Mailing Address - Fax:
Practice Address - Street 1:26 CENTURY HILL DR STE 207
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2128
Practice Address - Country:US
Practice Address - Phone:518-238-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator