Provider Demographics
NPI:1144510280
Name:BENELLI, TYLER O (LCSW)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:O
Last Name:BENELLI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W WELLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1411
Mailing Address - Country:US
Mailing Address - Phone:570-662-1982
Mailing Address - Fax:570-662-2390
Practice Address - Street 1:114 EAST AVE
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1737
Practice Address - Country:US
Practice Address - Phone:570-723-0620
Practice Address - Fax:570-724-0675
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical