Provider Demographics
NPI:1316319312
Name:BENJAMIN, MILDRED SHANTEL (LMSW)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:SHANTEL
Last Name:BENJAMIN
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BENNETT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-6934
Mailing Address - Country:US
Mailing Address - Phone:318-557-7112
Mailing Address - Fax:
Practice Address - Street 1:1162 OLIVER RD STE 4
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5757
Practice Address - Country:US
Practice Address - Phone:318-340-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104571041C0700X, 104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator