Provider Demographics
NPI:1730537788
Name:BENAROYA, STACI JARYN (LCSW)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:JARYN
Last Name:BENAROYA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-2748
Mailing Address - Country:US
Mailing Address - Phone:914-400-5682
Mailing Address - Fax:
Practice Address - Street 1:35 MARILYN BLVD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1942
Practice Address - Country:US
Practice Address - Phone:914-653-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720975081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical