Provider Demographics
NPI:1467326678
Name:GOYENECHEA BENITEZ, MADELIN IDELIS
Entity type:Individual
Prefix:
First Name:MADELIN
Middle Name:IDELIS
Last Name:GOYENECHEA BENITEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 GINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-7426
Mailing Address - Country:US
Mailing Address - Phone:786-899-6784
Mailing Address - Fax:
Practice Address - Street 1:5780 GINGHAM DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-7426
Practice Address - Country:US
Practice Address - Phone:786-899-6784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-477089106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty