MEDICARE: CYNTHIA BENIK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.017316	IL

General Provider Information

NPI Number	:	1548632888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA BENIK LCSW

Provider Business Mailing Address
First Line	:	2834 N DAWSON AVE
Second Line	:	APT. 1W
City	:	CHICAGO
State	:	IL
Zip	:	60618-2578
Country	:	US
Telephone Number	:	630-433-8706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2834 N DAWSON AVE
Second Line	:	APT. 1W
City	:	CHICAGO
State	:	IL
Zip	:	60618-2578
Country	:	US
Telephone Number	:	630-433-8706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2015
Last Update Date	:	10/27/2015

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