Active NPI
Bryan Benitez, PHD
- Psychologist
- Wallingford, CT
National Provider Identifier
1114892080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 004591
- Practice address
- 41 Highland Ave
Wallingford, CT 06492-2105 - Phone
- (786) 316-1957
- NPI assigned
- Oct 9, 2025
- Last updated
- Oct 9, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 004591 | CT | Primary |
Addresses
Primary practice location
41 Highland Ave
Wallingford, CT 06492-2105
Mailing address
41 Highland Ave
Wallingford, CT 06492-2105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004591 | CT | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759968000000",
"number": "1114892080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 HIGHLAND AVE",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064922105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 HIGHLAND AVE",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064922105",
"telephone_number": "786-316-1957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENITEZ",
"first_name": "BRYAN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-10-09",
"last_updated": "2025-10-09",
"certification_date": "2025-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CT",
"license": "004591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wallingford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.