Provider Demographics
NPI:1821196411
Name:BENZ, JANICE (LMSW)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:BENZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 GLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14813-9534
Mailing Address - Country:US
Mailing Address - Phone:585-268-5582
Mailing Address - Fax:
Practice Address - Street 1:115 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1508
Practice Address - Country:US
Practice Address - Phone:607-776-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00762801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00070286Medicaid
NY076280Medicaid