Provider Demographics
NPI:1992075899
Name:BENJAMIN, DONNA GAIL (MA, MFT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:GAIL
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 MANITOBA ST
Mailing Address - Street 2:UNIT 318
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5731 W SLAUSON AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6537
Practice Address - Country:US
Practice Address - Phone:310-906-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist