MEDICARE: SHARON SUSAN BENTON 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	2092-C	AR

General Provider Information

NPI Number	:	1952685398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON SUSAN BENTON LCSW

Provider Business Mailing Address
First Line	:	1513 W FIR ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-5031
Country	:	US
Telephone Number	:	479-721-2230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 W FIR ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-5031
Country	:	US
Telephone Number	:	479-721-2230
Fax Number	:

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

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	10/04/2011

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