Provider Demographics
NPI:1427451673
Name:BENITEZ, DANIEL VINCENTE (LCSW 100120)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:VINCENTE
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:LCSW 100120
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1901
Mailing Address - Country:US
Mailing Address - Phone:909-580-6646
Mailing Address - Fax:
Practice Address - Street 1:325 HERMOSA AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1901
Practice Address - Country:US
Practice Address - Phone:909-580-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85944101YM0800X
171M00000X, 390200000X
CA1001201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program