Provider Demographics
NPI:1053793000
Name:BENWAY, BRITTNEY MARIE
Entity type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:MARIE
Last Name:BENWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:MARIE
Other - Last Name:JAQUISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:KEESEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944-3609
Mailing Address - Country:US
Mailing Address - Phone:518-834-7071
Mailing Address - Fax:
Practice Address - Street 1:1717 FRONT ST
Practice Address - Street 2:
Practice Address - City:KEESEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12944-3609
Practice Address - Country:US
Practice Address - Phone:518-834-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator