Provider Demographics
NPI:1811615610
Name:BENEGAS, TARA LUCILLE
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LUCILLE
Last Name:BENEGAS
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 1:6113 EASTON CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5968
Mailing Address - Country:US
Mailing Address - Phone:720-331-1095
Mailing Address - Fax:
Practice Address - Street 1:6113 EASTON CIR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80504-5968
Practice Address - Country:US
Practice Address - Phone:720-331-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000009441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical