Provider Demographics
NPI:1659737682
Name:BENINCASA, KARISSA BIANKA
Entity type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:BIANKA
Last Name:BENINCASA
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 1:7300 BROMPTON ST
Mailing Address - Street 2:APT 5311
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2180
Mailing Address - Country:US
Mailing Address - Phone:305-431-1572
Mailing Address - Fax:
Practice Address - Street 1:6701 PINEMONT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-3132
Practice Address - Country:US
Practice Address - Phone:832-209-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT17500225X00000X
TX117776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist