Provider Demographics
NPI:1538995196
Name:BENAVIDES LEZO, MARIA ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELIZABETH
Last Name:BENAVIDES LEZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:ELIZABETH
Other - Last Name:BENAVIDES MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5445 E BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2207
Mailing Address - Country:US
Mailing Address - Phone:323-594-0247
Mailing Address - Fax:
Practice Address - Street 1:5445 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2207
Practice Address - Country:US
Practice Address - Phone:323-594-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1072781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty