Provider Demographics
NPI:1528824026
Name:BENJAMIN, STEPHANIE (RBT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BRAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1205 ANDUIN AVE
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4495
Mailing Address - Country:US
Mailing Address - Phone:469-487-4075
Mailing Address - Fax:
Practice Address - Street 1:355 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2199
Practice Address - Country:US
Practice Address - Phone:808-727-5500
Practice Address - Fax:808-984-5627
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1528824026.106S00000X
TNRBT-23-297444106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician