Provider Demographics
NPI:1902810328
Name:CHERNYK, BENITA KAY I (PHD, CEAP, LICDC-S)
Entity Type:Individual
Prefix:DR
First Name:BENITA
Middle Name:KAY
Last Name:CHERNYK
Suffix:I
Gender:F
Credentials:PHD, CEAP, LICDC-S
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 202653
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-8127
Mailing Address - Country:US
Mailing Address - Phone:216-382-2929
Mailing Address - Fax:216-751-8348
Practice Address - Street 1:6133 ROCKSIDE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2223
Practice Address - Country:US
Practice Address - Phone:216-382-2929
Practice Address - Fax:216-751-8348
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4412103T00000X, 103TC0700X
OH933731101YA0400X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0825727Medicaid
OHCHCP10295Medicare PIN
OHR-41771Medicare UPIN