Basic Information
| Provider Information | |||||||||
| NPI: | 1699151795 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BENITEZ-MCCRARY | ||||||||
| FirstName: | MERCEDES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10015 OLD COLUMBIA RD | ||||||||
| Address2: | B215 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210461703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103127631 | ||||||||
| FaxNumber: | 4105101779 | ||||||||
| Practice Location | |||||||||
| Address1: | 14409 GREENVIEW DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207084213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014988100 | ||||||||
| FaxNumber: | 3014980009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2015 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 01107 | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.