Provider Demographics
NPI:1871697227
Name:BENESCH, HOWARD ISRAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ISRAEL
Last Name:BENESCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-0349
Mailing Address - Country:US
Mailing Address - Phone:401-625-1431
Mailing Address - Fax:401-683-6970
Practice Address - Street 1:11 KING CHARLES DRIVE
Practice Address - Street 2:SUITE 11 4B
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871
Practice Address - Country:US
Practice Address - Phone:401-625-1431
Practice Address - Fax:401-683-6970
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00155103TC0700X
MA1841103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0504165Medicaid
RI9009326Medicaid
RI9009326Medicaid