Healthcare Provider Details

I. General information

NPI: 1922378751
Provider Name (Legal Business Name): JENNIFER JESSIE BENSON LMFT #86969
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CHADBOURNE RD
FAIRFIELD CA
94534-9656
US

IV. Provider business mailing address

520 CHADBOURNE RD
FAIRFIELD CA
94534-9656
US

V. Phone/Fax

Practice location:
  • Phone: 707-366-3672
  • Fax:
Mailing address:
  • Phone: 707-880-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT86969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: