Healthcare Provider Details

I. General information

NPI: 1780701995
Provider Name (Legal Business Name): GEORGE JAMES BENKER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 GRAND AVE
PIEDMONT CA
94610-1002
US

IV. Provider business mailing address

1250 GRAND AVE
PIEDMONT CA
94610-1002
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-7880
  • Fax: 510-655-3379
Mailing address:
  • Phone: 510-655-7880
  • Fax: 510-655-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: